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1.
目的:评价经纤维支气管镜下不同取材对结节病诊断的价值.方法:回顾性分析45例经纤支镜检查,采用支气管肺泡灌洗液检查(BALF)、肺内活检(包括经支气管黏膜活检和经纤维支气管镜肺活检)、经气管镜针吸活检(TBNA)和经气管镜超声引导针吸活检术(EBUS-TBNA)等方法获取标本,经病理学或细胞学检查确诊为结节病的患者,比较不同取材及联合取材检测结节病的阳性率.结果:经EBUS-TBNA和T3NA诊断为结节病的患者的阳性率分别为86.7%和82.5%,与BALF(60%)和肺内活检(50%)检查的阳性率相比,差异有显著性.结论:纤支镜检查是确诊结节病的重要手段之一,EBUS-TBNA和TBNA检查创伤性小、安全性好、准确率高,在结节病的诊断中有较高的应用价值.  相似文献   

2.
目的 探讨针吸活检术在结节病诊断中的临床价值.方法 对35例临床表现和胸部CT检查疑似结节病患者,先后行支气管肺泡灌洗液检查(BALF)、肺内活检(包括经支气管黏膜活检和经纤维支气管镜肺活检)、经支气管针吸活检术(TBNA)和经气管镜超声引导针吸活检术(EBUS-TBNA).结果 35例患者最终有30例确诊为结节病.经EBUS-TBNA和TBNA诊断为结节病的患者分别26例(86.7%)和24例(80%),与BALF(60%)和肺内活检(40%)检查的阳性率相比,差异有显著性.结论 EBUS-TBNA和TBNA检查创伤性小、安全性好、准确率高,在结节病的诊断中有较高的应用价值.  相似文献   

3.
目的提高对胸内结节病的认识,减少误诊。方法对组织病理确诊为胸内结节病的41例患者临床资料进行回顾性分析。结果 41例患者临床表现不典型;胸部CT表现为肺门及纵隔淋巴结肿大;90.2%伴有肺内病变,19.5%伴有浅表淋巴结肿大或皮下结节。41例均经淋巴结、皮下结节活检,或气管镜、纵隔镜、开胸活检确诊为结节病。其中31.7%(13/41)在外院曾被误诊为肺结核、肿瘤或其他疾病。结论结节病诊断是一种排他性诊断,临床高度怀疑结节病时需活检,活检病理需要排除增殖性结核病及其他非干酪样肉芽肿性疾病方可诊断。  相似文献   

4.
肺结节病的临床研究——附21例报告   总被引:1,自引:1,他引:0  
目的:提高对结节病的认识。方法:回顾分析经病理确诊为结节病21例患者的临床资料。结果:胸部结节病多数有双侧肺门阴影对称性增大(71%)。63%的患者支气管肺泡灌洗液中CD4/CD8比值超过3.5。90%的患者结核菌素纯蛋白衍生物试验(PPD)为阴性。纤维支气管镜(纤支镜)支气管黏膜和肺活检及胸部小切口开胸肺活检病理确诊阳性率分别为80%和100%。结论:胸部X线、PPD及支气管肺泡灌洗液CD4/CD8检查有助于诊断结节病。经纤支镜支气管黏膜和肺活检和胸部小切口开胸肺活检是简便易行,创伤小,阳性率高的方法,特别是后者,对疑难病例的确诊有重要的临床价值。  相似文献   

5.
目的:进一步探讨结节病的临床特征与诊断方法。方法:回顾性分析经病理确诊的92例结节病患者的临床资料。结果:本组结节病男∶女比为1∶1.48,年龄22~69岁,40~60岁占66.31%。以咳嗽、胸闷气短就诊者分别占55.43%,41.30%;肺外表现以皮肤损害、浅表淋巴结肿大多见。胸部影像学以双肺门及纵膈对称性淋巴结肿大为主要特征,52例患者伴不同程度肺浸润,8例合并单侧或双侧胸腔积液,影像学分期以Ⅰ,Ⅱ期为主。53例患者血清血管紧张素转化酶表达增高。约1/3患者经支气管镜活检确诊,余经浅表淋巴结、皮下结节、纵膈镜下或CT下纵膈淋巴结活检或开胸肺组织活检确诊。结论:结节病临床表现缺乏特异性,可应用胸部影像学、血管紧张素转化酶检测等相关辅助检查以及病理学检查确诊。  相似文献   

6.
目的:进一步探讨结节病的临床特征与诊断方法。方法:回顾性分析经病理确诊的92例结节病患者的临床资料。结果:本组结节病男∶女比为1∶1.48,年龄22~69岁,40~60岁占66.31%。以咳嗽、胸闷气短就诊者分别占55.43%,41.30%;肺外表现以皮肤损害、浅表淋巴结肿大多见。胸部影像学以双肺门及纵膈对称性淋巴结肿大为主要特征,52例患者伴不同程度肺浸润,8例合并单侧或双侧胸腔积液,影像学分期以Ⅰ,Ⅱ期为主。53例患者血清血管紧张素转化酶表达增高。约1/3患者经支气管镜活检确诊,余经浅表淋巴结、皮下结节、纵膈镜下或CT下纵膈淋巴结活检或开胸肺组织活检确诊。结论:结节病临床表现缺乏特异性,可应用胸部影像学、血管紧张素转化酶检测等相关辅助检查以及病理学检查确诊。  相似文献   

7.
5种肺活检方法在肺部块影诊断中的价值比较   总被引:3,自引:0,他引:3  
郭悦鹏  于维霞  杜鹃 《新医学》2002,33(6):340-341
目的:比较5种不同方法的肺活组织检查(肺活检)在肺部块影诊断中的临床价值。方法:门诊及住院患者经肺部X线照片和(或)CT检查结果诊断为肺部块影1180例,分别应用经纤维支气管镜(纤支镜)肺活检(829例),X线引导下肺活检(77例)、B超引导下肺活检(96例)、CT引导下肺活检(156例)及开胸肺活检(22例)进行检查,并对有关资料进行对比分析研究。结果:①中央型肺部块影,肺活检诊断阳性率最高是开胸肺活检为3/3,其余依次为CT引导下肺活检(94.6%)、B超引导下肺活检(78%)、经纤支镜肺活检(74.7%)及X线引导下肺活检(33%);②周围型肺部块影,肺活检诊断阳性率最高是开胸肺活检(100%),其余依次为CT引导下肺活检(97.5%)、B超引导下肺活检(80%)、X线引导下肺活检(73%)、经纤支镜下肺活检(24.9%);③肺部块影总检出率最高是开胸肺活检(100%),其余依次为CT引导下肺活检(96.8%)、B超引导下肺活检(79%)、经纤支镜肺活检(62.1%)及X线引导下肺活检(62%);④并发症发生率依次为X线引导下肺活检(10%)、开胸肺活检(5%)、CT引导下肺活检(3.2%)、B超引导下肺活检(3%)、经纤支镜下肺活检(1%)。结论:综合考虑诊断阳性率高、费用低、并发症少等因素,对中央型肺部块影,经纤支镜肺活检宜作为首选检查方法;对于周围型肺部块影,CT引导下穿刺肺活检  相似文献   

8.
肺弥漫性疾病经纤维支气管镜肺活检诊断分析   总被引:4,自引:2,他引:2  
目的:评价经纤维支气管镜肺活检对肺弥漫性疾病病因的诊断价值。方法:在X线透视下,对185 例肺弥漫性疾病患者,行纤维支气管镜肺活检取得肺组织,进行病理检查,并对临床资料和病理诊断进行回顾性分析。结果:本组肺弥漫性疾病病因诊断率为77% ,主要有特发性肺纤维化76 例(41% );继发性肺纤维化14例(7 %) ;肺癌22 例(11% );肺结核10 例(5 %) ;肺结节病9 例(4% ),未能得出诊断44 例(23 %) 。结论:经纤维支气管镜肺活检对肺弥漫性疾病病因具有较高的诊断价值  相似文献   

9.
目的探讨超声引导下经支气管针吸活检(EBUS-TBNA)在肺结节病中的诊断价值。方法回顾性分析130例肺结节病患者的临床表现、实验室及影像学检查等资料。结果本研究肺结节病患者中,Ⅰ期101例,Ⅱ期28例,Ⅲ期1例。临床表现主要为呼吸系统症状,影像学可表现为肺门及纵隔淋巴结肿大、肺内及胸膜病变等。本研究患者均进行淋巴结活检,其中应用EBUS-TBNA明确诊断者119例(91. 5%)。结论肺结节病临床表现无特异性,影像学发现双侧肺门及纵隔淋巴结肿大者应怀疑为此病。EBUS-TBNA具有创伤小、对Ⅰ及Ⅱ期结节病诊断率高特点,在肺结节病的诊断中具有重要价值。  相似文献   

10.
纤维支气管镜对肺结节病的诊断价值   总被引:6,自引:0,他引:6  
目的 研究纤维支气管镜对肺结节病的诊断价值,提高临床诊断符合率。方法 对22例肺结节病的临床资料进行回顾性调查分析。结果有病理学依据的22例肺结节病。男7例,女15例;年龄14-66岁,症状除了呼吸道症状外,还有多系统损害表现,胸部X线片及CT提示双侧肺门肿大21例,单侧肺门肿大1例,纵隔淋巴结肿大16例,经皮肤黏膜淋巴结活检确诊8例,纤维支气管镜活检确诊14例。其中纤维支气管镜阳性率为77.8(14/18),结节病分类Ⅰ期16例,Ⅱ期6例。结论 提示纤维支气管镜检查有助于肺结节病病理诊断并治疗。  相似文献   

11.
Oro-facial granulomatosis--a clinical and pathological analysis   总被引:4,自引:0,他引:4  
A study of 60 patients with oro-facial granulomatosis has been conducted and the clinical presentation of this disorder defined. It encompasses the previously recognised clinical entities of Melkersson-Rosenthal syndrome and cheilitis granulomatosa. The pathological features of the disease are lymphoedema and the presence of multiple non-caseating giant cell granulomata. These granulomata are histologically indistinguishable from those found in both gastrointestinal Crohn's disease and systemic sarcoidosis. Within this series of patients, nine had evidence suggestive of gastrointestinal Crohn's disease, and in six this was confirmed. A diagnosis of sarcoidosis was made in a further two patients. The relationship of oro-facial granulomatosis to these systemic granulomatous diseases is not yet clear. Patients with oro-facial granulomatosis who have gastrointestinal symptoms should be investigated for the presence of gastrointestinal Crohn's disease. Those without symptoms should be investigated for evidence of malabsorption or serological evidence of Crohn's disease. Within the present study, the erythrocyte sedimentation rate, full blood count, corrected whole blood folate, serum albumin and calcium were the most sensitive markers of gastrointestinal involvement. Sarcoidosis should be considered in all patients with oro-facial granulomatosis. The absence of clinical signs suggestive of sarcoidosis, a normal chest radiograph and normal levels of serum angiotensin-converting enzyme makes sarcoidosis unlikely.  相似文献   

12.
13.
Sarcoidosis is a granulomatous, multisystem disease. Rarely, sarcoidosis may present with both renal failure and hypercalcemia. A 27-year-old black man presented with severe abdominal pain and renal failure. A kidney biopsy demonstrated features of both interstitial nephritis and membranous glomerulopathy thought to be secondary to nonsteroidal anti-inflammatory drugs. His renal function and symptoms improved with short-term prednisone therapy. Discontinuation of steroids led to a recurrence of renal failure and severe hypercalcemia. On the basis of an elevated angiotensin-converting enzyme level of 160 U/L and anemia, a bone marrow biopsy was performed. Acid-fast bacillus-negative, noncaseating granulomas suggested the diagnosis of sarcoidosis. The patient recovered after restarting prednisone. Sarcoidosis may cause both interstitial and membranous nephritis from direct infiltration. Hypercalcemia results from increased calcium absorption secondary to 1,25-dihydroxyvitamin D production by sarcoid granulomas. Sarcoidosis must be considered in the differential diagnosis of renal failure in black patients. Serum calcium and angiotensin-converting enzyme levels may aid the diagnosis.  相似文献   

14.
Interstitial lung disorders are a heterogeneous group of diseases that result in a similar clinical presentation and have similar physiologic consequences on lung function. Our current understanding of these disorders indicates that there is an inflammatory component of these diseases that is reversible and that precedes the development of interstitial pulmonary fibrosis, which is irreversible. Although conclusive clinical studies are still lacking, treatment of pulmonary disease in these patients is based on the concept that treatment of the inflammatory component of the disease with immunosuppressive agents will prevent or reduce the amount of pulmonary fibrosis that develops. Because of the significant side effects associated with immunosuppressive drugs, therapy should be used only when there is likely to be therapeutic benefit. The use of immunosuppressive agents is, therefore, indicated in selected groups of patients. If there is a known precipitating agent for the interstitial disorder, such as asbestos exposure, the primary therapy is to avoid further exposure to the agent. Sarcoidosis is one of the most common systemic disorders associated with interstitial lung disease, and in this disease, corticosteroids clearly are of benefit. In pulmonary sarcoidosis, patients who are symptomatic or patients who demonstrate progressive clinical deterioration of pulmonary function should be treated. Recent studies also suggest that patients with a high degree of pulmonary inflammation as demonstrated by a positive gallium scan and a high percentage (greater than 28%) of lymphocytes obtained on lung lavage may also benefit from corticosteroid therapy. Idiopathic pulmonary fibrosis is a progressive disease and is usually symptomatic at the time of presentation, so it is reasonable to give all patients a therapeutic trial with corticosteroids.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

15.
Sarcoidosis is a multisystem disorder of unknown thiology. Patients with sarcoidosis present a variety of manifestations. The clinical feature of this disorder depends on age, gender and ethnicity of the patients, duration and activity of the illness, site and extent of organ involvement. In Japanese patients, ocular lesions as in prevalence cases showed a marked increase in recent years, while the proportion of patients with BHL or pulmonary involvement detected by chest X-ray mass survey was decreasing. Of symptoms at presentation, ocular symptom is most frequent and the following symptoms are skin manifestation, cough, general fatigue, fever and so on. Patients without symptoms at presentation are estimated as a quarter of patients. The diagnosis of sarcoidosis needs a compatible clinical feature and histologic demonstration of noncaseating granulomas. Additionally, other diseases presenting similar clinical pictures and/or pathologic findings should be excluded. In order to obtain a histologic confirmation of the disease and to assess extent, severity and activity of the disease, the further examinations for diagnostic work-up in patients with sarcoidosis are required after establishing clinical and radiological features.  相似文献   

16.
Sarcoidosis is a systemic granulomatous disease that the epidemiology remains unknown. The appropriate therapy for sarcoidosis also has not been well defined. Systemic therapy is clearly indicated for cardiac disease, neurologic disease, eye disease without response to topical therapy, hypercalcemia, and progressive symptomatic disease. Corticosteroid are very commonly used as systemic therapy for sarcoidosis. However, there are some patients who can not be controlled with corticosteroid alone and/or have adverse reactions to corticosteroid. Several cytotoxic agents, including methotrexate, azathioprine, cyclophosphamide, chlorambucil and cyclosporine A, have been used to treat sarcoidosis. There are no studies that have clearly concluded when these agents should be used for treatment. On the basis of safety and efficacy, methotrexate and azathioprine are the preferred drugs. The antimalarial agents, including chloroquine and hydroxychloroquine, most often used to treat sarcoidosis.  相似文献   

17.
Oro-Facial Granulomatosis -- a Clinical and Pathological Analysis   总被引:5,自引:0,他引:5  
A study of 60 patients with oro-facial granulomatosis has beenconducted and the clinical presentation of this disorder defined.It encompasses the previously recognised clinical entities ofMelkersson—Rosenthal syndrome and cheilitis granulomatosa.The pathological features of the disease are lymphoedema andthe presence of multiple non-caseating giant cell granulomata.These granulomata are histologically indistinguishable fromthose found in both gastrointestinal Crohn's disease and systemicsarcoidosis. Within this series of patients, nine had evidencesuggestive of gastrointestinal Crohn's disease, and in six thiswas confirmed. A diagnosis of sarcoidosis was made in a furthertwo patients. The relationship of oro-facial granulomatosisto these systemic granulomatous diseases is not yet clear. Patientswith oro-facial granulomatosis who have gastrointestinal symptomsshould be investigated for the presence of gastrointestinalCrohn's disease. Those without symptoms should be investigatedfor evidence of malabsorption or serological evidence of Crohn'sdisease. Within the present study, the erythrocyte sedimentationrate, full blood count, corrected whole blood folate, serumalbumin and calcium were the most sensitive markers of gastrointestinalinvolvement. Sarcoidosis should be considered in all patients with oro-facialgranulomatosis. The absence of clinical signs suggestive ofsarcoidosis, a normal chest radiograph and normal levels ofserum angiotensin-converting enzyme makes sarcoidosis unlikely.  相似文献   

18.
复发性结节病12例临床分析   总被引:2,自引:0,他引:2  
目的 探讨结节病复发的主要临床特点.方法 将结节病复发定义为:结节病的临床和影像改变自发或经治疗完全缓解后,又出现结节病活动的证据并经影像学或病理证实.2004年至2008年在我院就诊的符合上述标准的结节病复发患者共12例,对上述患者的临床资料进行总结分析.结果 12例中11例为女性,复发时间在缓解后4~38个月.12例结节病复发患者中10例在初治时接受了口服激素治疗,复发大多发生在激素减药过程中或停药早期,病情缓解超过3年复发的2例.3例在复发时有新发脏器受损.结论 结节病复发主要发生在激素减量或停药早期,但也有病情稳定数年后复发,结节病患者应接受长期随访,并规范口服激素治疗方案,结节病复发时应进行全面检查,重新评估受累脏器.  相似文献   

19.
Background: Some sarcoidosis patients never need therapy, butmany still require therapy more than 2 years after initial diagnosis. Aim: To determine what features at initial presentation areassociated with treatment 2 years later. Methods: Patients with biopsy-confirmed sarcoidosis enrolledin the ACCESS (A Case Control Etiologic Study of Sarcoidosis)study were initially evaluated within 6 months of diagnosis.Pulmonary function, chest X-ray and dyspnoea score were measured,and systemic therapy for the sarcoidosis recorded. Organ involvementwas assessed using a standardized instrument. A subset (n =215) were seen 18–24 months later for follow-up, and thesepatients constitute our study group. Results: Ten patients had only received therapy before the firstvisit, with no further therapy, and were excluded from analysis.Of the remaining 205, 95 were not on therapy at the initialvisit and 75 (79%) of these were never treated during follow-up.Of the 110 initially on therapy, 52 (47%) remained on therapyat follow-up. Other initial features associated with continuedtherapy were the level of dyspnoea and predicted vital capacity.On logistic regression, only dyspnoea and therapy at initialvisit remained significant. Patients on systemic therapy atinitial evaluation were more likely to be on therapy at follow-up(OR 3.6, p = 0.003). Neither ethnicity nor gender independentlypredicted therapy at follow-up. Discussion: This study group represents a sample of newly diagnosedsarcoidosis patients. However, this is a referral population,and there was no set protocol for treatment. Use of systemictherapy within the first 6 months after diagnosis appears tobe strongly associated with continued use of therapy 2 yearslater.  相似文献   

20.
Background: We have previously reported that the decrease in high-density lipoprotein (HDL)-cholesterol that is observed in patients with untreated sarcoidosis is limited to those with active disease. Aim: To determine the effect of corticosteroids, used in the treatment of active sarcoidosis, on the reported lipoprotein metabolism abnormalities. Methods: We studied 62 patients with biopsy-proven sarcoidosis, all of them with active disease. Sarcoidosis activity was evaluated by means of clinical, chest X-ray, gallium-67 scan, serum angiotensin-converting enzyme (peptidyl-dipeptidase A) values, and pulmonary function tests. A total of 40 patients were not treated with prednisone and 22 patients were treated with prednisone. The mean daily prednisone dosage in the treated patients with sarcoidosis was 20 mg and the mean duration of prednisone therapy was 6 months. Analysis of lipoprotein metabolism included: serum cholesterol, low-density lipoprotein (LDL)-cholesterol, HDL-cholesterol, HDL2-cholesterol, HDL3-cholesterol, apolipoprotein (apo) A-I, apo B, and triglyceride concentrations. Results: When patients with active sarcoidosis not treated with prednisone were compared to those treated with prednisone, the former had significantly lower HDL-cholesterol (1.17±0.36 vs. 1.42±0.42 mmol/l; P=0.01) and HDL2-cholesterol (0.37±0.18 vs. 0.53±0.25 mmol/l; P=0.009) levels. Multiple regression analysis demonstrated that the HDL-cholesterol (P=0.004), HDL2-cholesterol (P=0.002), HDL3-cholesterol (P=0.02), and apo A-I (P=0.02) levels were the variables independently and significantly associated with steroid therapy. Conclusions: Corticosteroid therapy, used in the treatment of active sarcoidosis, increased HDL-cholesterol levels to those seen in inactive disease. These changes are manifestations of reducing disease activity.  相似文献   

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