[结节病患者治疗过程中临床、x线和功能资料的动态变化]。

Klinicheskaia meditsina Pub Date : 2017-01-01
I Yu Vizel, A A Vizel
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引用次数: 0

摘要

目的:对结节病患者呼吸功能的文献资料和原创性研究结果进行分析。材料和方法:研究纳入1199例结节病患者(67.8%为女性,32.2%为男性,中位年龄43岁)。第一次x线分期为34.8%,II期为57.0%,III期为6.1%,IV期为1.3%,0期为0.7%。1例(0.1%)有胸膜结节病。20%的患者被诊断为洛夫格伦综合征。658例(54.9%)患者的诊断经活检证实。结果:结节病患者的影像学特征与肺量学特征有显著相关性。在患有洛夫格伦综合征的患者中,所有呼吸参数都比其他患者好得多。肺量测定参数的变化在吸烟者和合并肺部疾病的患者中更为明显。然而,在调整这些因素后,肺功能仍然受损,9.7%的病例对短效支气管扩张剂的使用有积极反应。Х-ray检查和肺活量测定是评价结节病患者健康状况的独立方法,在不同治疗方案后,两者的结果并不总是相互关联的。在接受强的松、甲氨蝶呤和己酮茶碱治疗的患者中,Х-ray图像和肺活量的变化是一致的,但在接受维生素E治疗和未接受治疗的患者中则不是这样。所有胸内结节病患者均建议肺量测定并同时进行x线检查。结论:肺用力肺活量(FVC)是评价结节病患者病情及治疗效果的独立标准。
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[Dynamics of clinical, X-ray and functional data during treatment of patients with sarcoidosis].

Aim: To analyze the literature data and the results of original studies on the respiratory function in patients with sarcoidosis.

Material and methods: The study included 1199 patients with sarcoidosis (67.8% women and 32.2% of males, median age 43 years). The first X-ray stage was documented in 34.8% of patients , stage II in 57.0%, stage III in 6.1%, stage IV in 1.3%, stage 0 in 0.7%. One patient (0.1%) had pleural sarcoidosis. Loefgren syndrome was diagnosed in 20% of the patients. In 658 patients (54.9%) the diagnosis was confirmed by biopsy studies.

Results: The patients with sarcoidosis exhibited significant correlation between radiographic and spirometric characteristics. In those with Loefgren syndrome, all breathing parameters were much better than in the remaining ones. Changes of spirometry parameters were more pronounced in smokers and in patients with concomitant lung diseases. However, the lung function remained impaired after adjustment for these factors, and 9,7% of the cases positively responded to the administration of a short-acting bronchodilator. Х-ray examination and spirometry are independent methods for the evaluation of the health status of patients with sarcoidosis and their results do not always correlate with each other after different treatment regimens. Changes in Х-ray image and lung vital capacity were consistent in patients treated with prednisone, methotrexate and pentoxifylline, but not in the cases treated with vitamin E and in the absence of treatment. Spirometry with simultaneous X-ray examination is recommended for all patients with intrathoracic sarcoidosis.

Conclusion: Forced vital capacity of lungs (FVC) is an independent criterion for evaluating the condition of patients with sarcoidosis and the effectiveness of the treatment.

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