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结节病什么时候可不治疗?无症状或无生化紊乱的肺门淋巴结病不需治疗;高血钙、迅速进展的肺部病变和眼、脑或心肌受累则是皮质类固醇治疗的适应症。虽然结节病病因未明,但现已明确肺损害的发病机制与T淋巴细胞有关。一些炎症活动性的测定,例如支气管肺泡灌洗液的淋巴细胞计数,或~(67)镓肺扫描,都有助于鉴定患者是否需要治疗。一些临床医生还测定血清的紧张索转化酶(angiotensin-converting en-zyme,ACE),但它的价值可疑。与支气管肺泡冲洗液淋巴细胞计数一样,血清 ACE 尚不能准确地反映肺部病变的活动性。显然血清 ACE 测定的价值是有限的。因此,许多临床医生将继续使用包括几十年临床经验在内的粗略指标。目前的治疗方案既不全面,也没有理论基础。据Denmark 回顾性研究提供的确实资料,243例患者随访10年,其中87％胸部 X 线各种异常在2年内自然改善,经过2年清晰的 X 线片可看作病情的稳定缓解。
When is the treatment of sarcoidosis? Asymptomatic or biochemical disorders hilar lymph node disease without treatment; Hypercalcemia, rapid progression of lung disease and eye, brain or myocardial involvement is an indication of corticosteroid therapy. Although the etiology of sarcoidosis is unclear, it is now clear that the pathogenesis of lung damage is related to T lymphocytes. Some measures of inflammatory activity, such as lymphocyte counts in bronchoalveolar lavage fluid, or ~ (67) gallium-based lung scans, can help identify patients for treatment. Some clinicians also measure serum angiotensin-converting en-zyme (ACE), but its value is questionable. As with bronchoalveolar lavage fluid lymphocyte counts, serum ACE does not accurately reflect lung disease activity. Obviously the value of serum ACE determination is limited. As a result, many clinicians will continue to use crude indicators that include decades of clinical experience. The current treatment plan is neither comprehensive nor theoretical. According to the retrospective study provided by Denmark, 243 patients were followed for 10 years, of which 87% of chest X-ray abnormalities naturally improve within 2 years, and after 2 years of clear X-ray film can be regarded as stable remission.