摘要
本病例为1例老年女性患者,主因"咳嗽、喘息、胸闷"5 d入院.该例患者胸部CT提示纵隔窗可见主动脉弓旁、隆突下及气管前腔静脉后间隙多发淋巴结肿大,未见融合及环形钙化;气管镜下气管黏膜未见明显异常,肺泡灌洗液CD4+/CD8+为4.6,纵隔淋巴结穿刺病理回报为非干酪样坏死性肉芽肿,抗酸染色阴性;结核、结缔组织病相关检查阴性,肺结节病诊断明确.因患者拒绝口服糖皮质激素治疗,且鉴于患者无肺外表现,经与患者沟通后给予布地奈德(2 mg/次,2次/d)治疗,治疗10 d后复查胸部CT见纵隔多发肿大淋巴结明显减小.通过该病例对肺结节病进行了相关文献复习,对结节病的药物治疗、生物标志物进行初步探讨.目前糖皮质激素仍为结节病的一线治疗药物,但由于结节病可自行缓解及易复发的特点,以及长期使用糖皮质激素可带来一系列不良反应,口服或吸入糖皮质激素的治疗选择、疗程及减药或停药均无统一推荐.对激素治疗无反应或复发以及不能耐受、存在禁忌证的患者或需要长期高剂量使用激素的患者,可考虑使用非糖皮质激素药物.各种生物标志物已经被大量研究用于评估结节病的缓解、预后分析,但是都被证明适用性有限.
Abstract
The case was an elderly female patient who was admitted to hospital for 5 days due to"cough,wheezing and chest tightness".In this case,chest CT showed multiple lymph node enlargement in the mediastinal window beside the aortic arch,subcarina and posterior space of anterior tracheal vena cava,without fusion and circular calcification.Tracheoscopy showed no significant abnormalities in trachea mucosa,alveolar lavage fluid CD4+/CD8+was 4.6,mediastinal lymph node puncture pathology reported non-caseous necrotizing granuloma,and antacid staining was negative.Tuberculosis and con-nective tissue related tests were negative,and the diagnosis of pulmonary sarcoidosis was confirmed.Since the patient re-fused oral glucocorticoid therapy and had no extrapulmonary manifestations,Budesonide(2 mg/time,2 times/day)was given after communication with the patient.Chest CT examination 10 days after treatment showed a significant reduction in multi-ple enlarged mediastinal lymph nodes.Based on this case,the relevant literature of pulmonary sarcoidosis was reviewed,and the drug therapy and biomarkers of sarcoidosis were preliminarily discussed.At present,glucocorticoids are still the first-line treatment for sarcoidosis.However,due to the characteristics of self-remission and easy recurrence of sarcoidosis,as well as a series of adverse reactions caused by long-term use of glucocorticoids,there is no uniform recommendation for the treatment choice,course of treatment,reduction or discontinuation of oral or inhaled glucocorticoids.Non-glucocorticoid drugs may be considered for patients who do not respond to or relapse from hormone therapy,are intolerant,have contraindi-cations,or require long-term high doses of hormones.Various biomarkers have been used in numerous studies to assess re-mission and prognosis of sarcoidosis,but have proved to be of limited applicability.
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