【作者】 郑毅；

【导师】 代静泓；

【作者基本信息】 南京大学 ， 内科学（呼吸病学）（专业学位）， 2019， 硕士

【摘要】 目的探讨糖皮质激素治疗的结节病患者疾病复发率及复发相关危险因素。方法回顾性分析病理确诊的接受糖皮质激素治疗的肺结节病患者临床特征、影像学分期、肺功能检查和治疗信息。肺结节病的复发定义为激素剂量减量和停药过程中,患者咳嗽、气喘等临床表现恶化,伴随胸部高分辨率CT(High Resolution Computed Tomography,HRCT)显示新出现胸部影像学异常或原有的影像学异常范围进展,需要激素加量或重新使用激素控制病情,并排除感染、心力衰竭或肺栓塞等其他因素导致的病情恶化。不复发定义为停药至少6个月后,临床症状和影像学表现消失或病变保持稳定。本研究主要研究终点是肺结节病的复发。结果本研究纳入2012年1月至2018年12月南京大学附属鼓楼医院呼吸与危重症医学科的203例肺结节病患者。其中96例接受糖皮质激素治疗,包括初次诊断时接受治疗的患者83例(86.46%),以及初次诊断未接受糖皮质激素治疗,随访中因疾病进展而使用糖皮质激素治疗的患者13例(13.54%)。随访观察30例患者出现疾病复发,复发率为30/96(31.25%)。单变量分析表明,吸烟史(HR=3.599,95%CI 1.543-8.395,P=0.003)、循环中性粒细胞升高(百分比>70%,HR=2.277,95%CI 1.106-4.689,P=0.026)和乳酸脱氢酶(LDH)升高(HR=1.003,95%CI 1.001-1.005,P=0.011)与糖皮质激素治疗后肺结节病复发显著相关。多变量分析显示,吸烟史(HR=3.674 95%CI 1.573-8.581,P=0.003)和循环中性粒细胞升高(HR=2.211,95%CI 1.073-4.557,P=0.032)是糖皮质激素治疗肺结节病的复发危险因素。结论本研究显示糖皮质激素治疗的结节病患者复发常见,吸烟史和循环中性粒细胞升高是疾病复发的危险因素。本研究为临床医师制定肺结节病患者的治疗策略提供参考依据。更多还原

【Abstract】 Objective To evaluate the incidence and risk factors of relapse in pulmonary sarcoidosis treated with corticosteroids.Methods Medical records of patients with pulmonary sarcoidosis were retrospectively reviewed.Clinical features,chest radiographs,pulmonary function tests and treatment information were collected.The starting point was the date of diagnosis.Clinical relapse was defined as chest high resolution computed tomography(HRCT)showing radiographic progression in combination of worsening of clinical symptoms to warrant retreatment following a decrease in dose or discontinuation of corticosteroids,without alternative causes such as infections,heart failure or pulmonary embolism.Non-relapse was defined as remission of clinical symptoms and chest abnormalities,or clinical syndromes improvement with retaining or stable of radiographic abnormalities after corticosteroids were withdrawn for at least six months.The primary endpoint was the occurrence of relapse.Results Two hundred and three patients with newly biopsy-proven pulmonary sarcoidosis were enrolled over a 7-year period.Among them,96 patients received corticosteroids therapy.Relapse occurred in 30 patients with the relapse rate yielding 30/96(31.25%).In univariate analysis,smoking history(HR = 3.599,95% CI 1.543–8.395,P = 0.003),increased percentages of circulating neutrophils(> 70%,HR = 2.277,95% CI 1.106– 4.689,P = 0.026),and lactate dehydrogenase(LDH)(HR = 1.003,95% CI 1.001–1.005,P = 0.011)were significantly associated with relapse in pulmonary sarcoidosis treated with corticosteroids.After adjustment,multivariate analysis showed that smoking history(HR=3.674 95%CI 1.573-8.581,P = 0.003)and increased percentages of circulating neutrophils(HR = 2.211,95% CI 1.073-4.557,P = 0.032)were the significant predictors of relapse in pulmonary sarcoidosis treated with corticosteroids.Conclusions This study provided a useful information that the relapse and associated risk factors should be taken into considerations when determining treatment strategies for patients with pulmonary sarcoidosis.更多还原