Mathur A, Kremer J M
Rheumatology and Internal Medicine, Marlborough Hospital, MA 01752.
Curr Opin Rheumatol. 1993 Jan;5(1):90-4. doi: 10.1097/00002281-199305010-00014.
Sarcoidosis is a clinical expression of intricate immune events. Firm evidence exists that unchecked helper T-cell proliferation restricted to the site of disease activity is the pivotal aberration. Alveolar macrophages from patients with sarcoidosis have been observed to release high levels of tumor necrosis factor-alpha and interleukin-2 and to exhibit enhanced expression of leukocyte function antigen 1 and intercellular adhesion molecule 1. These cytokines and adhesion molecules could result in compartmentalized T-cell proliferation at certain sites of disease. A new marker, serum procollagen type III-derived peptide, is reported to correlate with disease activity. Arthrosonography revealed periarticular edema as the prime pathologic process in the acute sarcoid reaction. Magnetic resonance imaging has greater diagnostic utility than does computed tomography in sarcoid myopathy. The acute sarcoid reaction is associated with a distinct HLA type and resolves spontaneously in 1 to 6 months. Chronic sarcoid arthritis causes destructive and deforming changes that rarely can be akin to Jaccoud's type arthropathy. Muscle and osseous disease is rare and asymptomatic. Nonsteroidal anti-inflammatory drugs and corticosteroids are the mainstays of pharmacotherapy. Deflazacort is an effective and safe steroid preparation with a lesser incidence of osteoporosis when used for long periods.
结节病是复杂免疫事件的一种临床表现。确凿证据表明，局限于疾病活动部位的辅助性T细胞不受控制地增殖是关键异常。已观察到结节病患者的肺泡巨噬细胞会释放高水平的肿瘤坏死因子-α和白细胞介素-2，并表现出白细胞功能抗原1和细胞间黏附分子1的表达增强。这些细胞因子和黏附分子可能导致疾病某些部位的局限性T细胞增殖。据报道，一种新的标志物血清Ⅲ型前胶原衍生肽与疾病活动相关。关节超声检查显示关节周围水肿是急性结节病反应的主要病理过程。在结节病性肌病中，磁共振成像比计算机断层扫描具有更大的诊断效用。急性结节病反应与一种独特的HLA类型相关，并在1至6个月内自发缓解。慢性结节病性关节炎会导致破坏性和变形性改变，很少类似于雅库病性关节病。肌肉和骨骼疾病罕见且无症状。非甾体抗炎药和皮质类固醇是药物治疗的主要手段。去氟可特是一种有效且安全的类固醇制剂，长期使用时骨质疏松的发生率较低。
