Rizzato G, Montemurro L, Colombo P
Medical Division Vergani, Niguarda Hospital, Milan, Italy.
Sarcoidosis Vasc Diffuse Lung Dis. 1998 Mar;15(1):52-8.
The aim of the study was to evaluate, in a white population with chronic sarcoidosis, the rate and pattern of relapses, the correlated factors, and the course of disease after prednisone withdrawal.
We have retrospectively examined the charts of 702 consecutive patients with histologically proven sarcoidosis, first seen in the Milan Sarcoidosis Clinic in the period October 1978-October 1994. 239 patients required corticosteroid therapy; in 82 it was possible to discontinue prednisone therapy and to have a follow-up of at least 18 months after withdrawal.
A relapse, requiring a new course of steroids, was observed in 30 (36.6%) of the 82 patients (R group). The other 52 patients (No-R group) did not relapse during a mean follow-up of 36.8 +/- 24.8 months (range 18-125). There were no relapses after 3 asymptomatic years of prednisone withdrawal. Extrapulmonary sarcoidosis was a reason for giving therapy in 46.6% of patients in the R group, vs 23.0% in the No-R group (P < 0.05). The first course of therapy lasted 22 months [median time; i.q. 11.5 to 34.5] in R group vs 26 months [i.q. 18 to 41] in No-R group (P > 0.05). The mean daily prednisone dose was higher in the R group: 17 mg [median value; i.q. 8.9 to 23.2] vs 10.6 mg [i.q. 8.1 to 13.8] in the No-R group (p < 0.05). Logistic regression confirmed the prognostic significance of mean daily prednisone dose and of extrapulmonary sarcoidosis at presentation (P < 0.01). A mild sarcoid activity at the time of withdrawal was still present in 51.9% of patients who did not relapse, and in 66.7% of patients who relapsed (p > 0.05). Relapse in the first year after withdrawal of prednisone therapy occurred in twenty-five of the 30 patients. The pattern of relapse was different from the initial manifestation in 5. Nine of the 30 patients could ultimately be weaned successfully from prednisone.
Relapses occurred in 36.6% of cases, and their pattern was the same as the initial manifestation in the majority of cases. A mild sarcoid activity at the time of withdrawal is not a reason for continuing steroids when the disease is abating. In our white population severe irreversible pulmonary impairment is rare, and even patients requiring chronic therapy need low prednisone dosage, usually around 10 mg daily, to control the disease in the late course.
本研究旨在评估慢性结节病白人患者的复发率及模式、相关因素以及停用泼尼松后的疾病进程。
我们回顾性查阅了1978年10月至1994年10月期间在米兰结节病诊所初诊的702例经组织学证实的结节病患者的病历。239例患者需要糖皮质激素治疗；其中82例患者停用了泼尼松治疗，并在停药后进行了至少18个月的随访。
82例患者中有30例（36.6%）复发（R组），需要重新使用类固醇治疗。另外52例患者（非R组）在平均36.8±24.8个月（范围18 - 125个月）的随访中未复发。停用泼尼松3年无症状后无复发情况。肺外结节病是R组46.6%患者接受治疗的原因，而非R组为23.0%（P<0.05）。R组首个疗程治疗持续22个月[中位时间；四分位间距11.5至34.5]，非R组为26个月[四分位间距18至41]（P>0.05）。R组泼尼松平均每日剂量更高：17mg[中位值；四分位间距8.9至23.2]，非R组为10.6mg[四分位间距8.1至13.8]（P<0.05）。逻辑回归证实了初诊时每日泼尼松平均剂量和肺外结节病的预后意义（P<0.01）。未复发患者中51.9%以及复发患者中66.7%在停药时仍有轻度结节病活动（P>0.05）。泼尼松治疗停药后第一年，30例患者中有25例复发。30例患者中有5例复发模式与初始表现不同。30例患者中有9例最终成功停用泼尼松。
36.6%的病例出现复发，大多数病例的复发模式与初始表现相同。疾病缓解时，停药时的轻度结节病活动并非继续使用类固醇的理由。在我们的白人患者群体中，严重不可逆肺损害罕见，即使需要长期治疗的患者也只需低剂量泼尼松，通常每日约10mg，即可在疾病后期控制病情。
