Dergiler / Solunum / 2008 / Cilt: 10 - Sayı: 2
Sarkoidozda evrelere göre klinik özellikler ve tanı yöntemleri: 55 olgunun değerlendirilmesi
- Dergi
- Solunum
- Sayfa
- 89–96
- DOI
- —
Özet
Amaç: Bu çalışmada amaç bölgemizde sarkoidozun klinik ve laboratuvar özelliklerini, radyolojik evre ile bu parametreler arasındaki ilişkilerini incelemek ve akciğer dışı organ tutulumlarını saptamaktı. Gereç ve yöntem: Kliniğimizde Ocak 2003 - Haziran 2007 tarihler arasında sarkoidoz tanısı konulan 55 olgu geriye dönük olarak incelendi. Bulgular: Ortalama yaş kadınlarda (52.14±10.44) erkeklerden (39.54±9.44) anlamlı olarak yüksekti (p 0.05). Evre ilerledikçe solunum fonksiyon test (SFT) parametrelerinden 1. saniye zorlu ekspiratuar hacim (FEV1), zorlu vital kapasite (FVC), FEV1/FVC oranı, total akciğer kapasitesi (TLC) ve karbon monoksit difüzyon kapasitesi (DLCO) değerlerinde düşme izlendi. Radyolojik evre ile FEV1, FVC ve TLC arasında istatistiksel olarak anlamlı negatif korelasyon (değerler sırasıyla p: 0.003, r: -0.426; p: 0.018, r: -0.340; p: 0.004, r: -0.444) saptandı. Sonuç: Sarkoidozun sıklığı, klinik özellikleri, radyolojik görünümü, akciğer dışı organ tutulum oranı ve prognozu bölgesel farklılıklar göstermektedir. Ülkemizde hastalığın tamolarak bilinmeyen sıklık, seyir ve prognozunun belirlenebilmesi, etnik ve bölgesel farklılıkların saptanabilmesi için çok merkezli çalışmalara gereksinim vardır.
Abstract
Aim: The aim of this study was to determine the clinical and laboratory characteristics, the extrapulmonary involvement and the association between the radiological stages and these parameters in sarcoidosis patients of our geographic area. Material and methods: Fifty five patients who were diagnosed to have sarcoidosis in our department between January 2003 and June 2007 were retrospectively evaluated. Results: The mean age was significantly higher in female (52.14±'b110.44) than male patients(39.54±'b19.44) (p<0.001). In radiological staging, 21 (38.2%) patients were in stage 1, 29 (52.7%) in stage 2 and five (9.1%) in stage 3. Skin lesions (34.5%) (erythema nodosum, 20%), palpable lymphadenopathy (14.5%), splenomegaly (9.1%), hypercalcemia (15.5%), hepatomegaly (7.3%), hepatosplenomegaly and uveitis (5.8%), nephrolithiasis (3.6%), parotid gland hyperplasia and scar sarcoidoisis (1.8%) were seen in our patients. Serum level of angiotensin converting enzyme (ACE) was high in 23 (59.4%) of 38 and tuberculine skin test (TST) was negative in 36 (76.6%) of 47 patients. Lymphocyte percentage in bronchoalveolar lavage fluid (BAL) was equal to or more than 28% in 18 (72%) of 25 patients; CD4/CD8 ratio was above 3.5 in 15 (62.5%) of 24 cases. Diagnosis was confirmed histopathologically in 42 patients, and with clinical and radiological findings in 13 patients. No significant correlation was found between the radiological staging and serum ACE level, TST, BAL lymphocyte ratio and CD4/CD8 ratio (p>0.05). Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), the ratio of FEV1/FVC, total lung capacity (TLC) and carbonmonoxide diffusion capacity (DLCO) were found to be decreased with increasing stage. There was a significant negative correlation between radiographic staging and FEV1, FVC and TLC (the values were p: 0.003, r: -0.426; p: 0.018, r: -0.340; p: 0.004, r: -0.444, respectively). Conclusion: The prevalence, clinical features, radiological findings, extra-pulmonary involvement and prognosis of sarcoidosis may present regional variations. In order to determine these variations in our country, multicenter studies should be conducted.