Clinical Features And Prognosis Of 88 Patients With Sarcoidosis And Study On The Expression Of Interleukin-22 In Sarcoidosis

Part 1 Clinical features and prognosis of 88 patients with sarcoidosisBackground and ObjectiveSarcoidosis is a non caseating necrotizing granulomaous disease that has unknown causes and involves multisystem of the whole body,the peak incidence is in the age of 25-45 and is more common in women.About 86%-92% will involve the lung and lymphatic system,followed by involving the skin and eyes.The most common clinical manifestations of sarcoidosis are cough and chest tightness,and the typical chest CT showed bilateral hilar and mediastinal lymph nodes with or without pulmonary infiltrates.Diagnosis of sarcoidosis requires a combination of clinical,imaging,pathology,and the exclusion of other granulomatous diseases.Due to atypical clinical manifestations of sarcoidosis and a high rate of misdiagnosis,it is essential to improve the understanding of sarcoidosis and reduce misdiagnosis,and clear the factors affecting prognosis of sarcoidosis has certain significance to the clinical treatment of sarcoidosis.methodCollect the clinical data of the hospitalized patients with sarcoidosis in Shanghai Changzheng Hospital from Jan 2000 to Feb 2014,and collect the clinical data of the hospitalized and outpatient patients with sarcoidosis from Mar 2014 to Dec 2014.A total of 88 cases,36 cases were male,52 cases were female.Clinical data collected includes general information: gender,age,smoking history,history of tuberculosis,history of exposure to dust;and clinical information: the initial presentation,radiological features,laboratory tests,pathological examination,therapy and prognosis.Using statistical method,measurement data were presented as mean ± standard,and using the methods of independent samples t test,chi-square test,multiple linear regression and COX regression.Taking P=0.05 as the test standard,when P<0.05 the difference had statistical significance.Results1.In 88 cases of sarcoidosis the ratio of male to female was 1: 1.44,age distribution with the highest proportion was 50-60 years old,37.5%,and the average age of the patients is 49.69±11.84.The proportion of patients who do not smoke is 72.73%,the proportion of patients with a history of tuberculosis is 5.68%.65 cases of patients with clear history of exposure to dust in 88 cases,of which 23 cases had history of exposure to dust,accounting for 35.38%.The first diagnostic departments were with respiratory and thoracic surgery mainly.The main clinical manifestations and symptoms are cough(44.32%),chest tightness(14.77%),weight loss(17.05%)and superficial lymph nodes(13.64%).There were no differences in clinical manifestations,laboratory examination between active and inactive.The proportion of men without clinical manifestations is 36.11%,more than women(15.38%),and the proportion of patients younger than 50 without clinical manifestations is 40.54%,more than older than 50(13.73%).88 cases of sarcoidosis patients with 3 cases were misdiagnosed,the misdiagnosis rate was 3.41%,of which 2 cases were misdiagnosed as tuberculosis,1 case was misdiagnosed as lung cancer.63.33% patients with sarcoidosis appeared elevated SACE,smoking can affect the activity of SACE.2.The radiological stage in 88 cases of sarcoidosis,stage I accounted for 48.84%,stage II accounted for 45.35%.63 patients with typical images,accounted for 73.26%.18 patients showed mediastinal lymph nodes alone,accounting for 20.93%.Pulmonary infiltrates with small nodules are in the majority,a total of 21 cases(51.22%),followed by the patchy shadows,12 cases(29.27%).7 cases underwent PET / CT examination,SUV range in the involved part is 2.60-18.87.7 patients had mediastinal and hilar lymph nodes,SUVmax average of 12.68;four cases of pulmonary infiltrates,SUVmax average of 8.80;3 cases of superficial lymph nodes,SUVmax average of 16.52;2 patients abdominal lymph nodes,SUVmax average of 17.29;1 case of mediastinal lymph nodes and lungs door with eyelid and under the chin granuloma,SUV value of 12.50.There were no differences in clinical manifestations,laboratory examination between the patients in stage I and stage II.There was no significant difference in patients with or without pulmonary involvement.3.62 patients with pathological examination,mediastinoscopy,thoracoscopy,lesions biopsy,bronchoscopy and percutaneous needle biopsy were the main ways of pathological examination,the diagnostic accuracy of mediastinoscopy?thoracoscopy and lesions biopsy are the highest,100%.57 cases(91.94%)showed non caseating necrotizing granulomaous.PAS staining in 10 cases,the results were negative.4.In 88 cases,45 cases received the treatment and prognosis of information.There were 29 cases received hormone therapy,with 13 cases of stage I and II,2 cases of stage 0(respectively expressed as rash and superficial lymph nodes),one case of non-imaging data(fever,superficial lymph nodes),16 cases of extrapulmonary organs involved 14 patients with respiratory manifestations,9 patients with systemic manifestations.16 patients did not receive treatment,including 5 cases of stage I,9 cases of stage II,2 cases of 0(respectively expressed as rash and weight loss),two cases of extrapulmonary organ involvement,6 patients had respiratory manifestations,five cases of systemic performance.21 patients condition improved after hormone therapy,accounting for 72.41%,disease duration up to 24 months,a minimum of two months,20 cases of radiological improvement,one case of clinical symptoms.11 patients with untreated spontaneous improvement,accounting for 68.75%,disease duration up to 12 months,a minimum of three months,six cases of radiological improvement,five cases of clinical symptoms.There was no statistically significant difference between the rate of hormone treatment improved and spontaneous remission.Conclusion.1.The lack of specific clinical manifestations of sarcoidosis,the most common clinical manifestations of cough,chest tightness,weight loss.The clinical manifestations are relatively uncommon in men and younger patients,the onset of more hidden.2.The elevation of SACE is more common in patients with sarcoidosis,smoking can affect the level of SACE.3.The image of stage I and II patients with sarcoidosis are typical presentation,clinical diagnostic rate is high;stage III and IV patients due to imaging no specificity,clinical attention is not enough,diagnosis rate is low.4.Mediastinoscopy,thoracoscopy and biopsy of skin lesions are the main methods for the pathologically diagnose of sarcoidosis.Part 2 Study on the expression of interleukin-22 in sarcoidosisBackground and ObjectiveSarcoidosis is a common combination of genetic,environmental,infectious and other factors,abnormal immune response,immunological pathogenesis is not very clear.There are a variety of cytokines and chemokines play a role in sarcoidosis granuloma formation,but there are still many factors of the function and mechanism of unknown.IL-22 as a member of the IL-10 family,the main function is to enhance epithelial barrier function,tissue homeostasis and promoting tissue repair and wound healing.IL-22 is mainly secreted by Th17 and Th22 cells,it has been detected in a variety of diseases of abnormal expression of IL-22.While its expression and role in sarcoidosis in the few studies.Ten Berge found that IL-22+CD3+T cells were increased in sarcoidosis lesion,and the number of IL-17+T cells and IL-22+CD3+T cells are related,IL-22 may be involved in the pathogenesis of sarcoidosis,but no follow-up study to explore the relationship between sarcoidosis and IL-22.This study was to detect the expression levels of IL-22 in the serum of patients with sarcoidosis,and to explore its clinical value.MethodCollecting 25 patients with sarcoidosis in Shanghai Changzheng Hospital between the time of Mar 2014 to Dec 2014,14 cases were male and 11 cases were female.While collecting 10 normal healthy volunteers as a control group,five cases of men and women.5ml of peripheral blood was taken from each person as the experimental study.Take 5ml venous blood for serum separation,using ELISA method to test the expression of cytokine IL-22.The measurement data using rank sum test(Mann-Whitney test);Count data using chi square test or Fisher exact test;Measurement data using Pearson correlation analysis;Multivariate analysis using binary logistics regression analysis;Diagnostic tests using receiver operating characteristic curve(ROC)to calculate the predictive value.Results1.In patients with sarcoidosis,serum IgA and SACE is higher than that of normal people.2.The expression of serum IL-22 in patients with sarcoidosis is higher than that of normal people,and it was positively correlated with the expression of IgA,and without correlation with age,sex,smoking history,history of dust exposure,radiographic stage,active,T cell subsets,IgG,IgM,SACE.3.The sensitivity of SACE diagnosis of sarcoidosis was 80%,the specificity was 100%;and the sensitivity of IL-22 diagnosis of sarcoidosis was 56%,the specificity was 100%;The sensitivity of IgA diagnosis of sarcoidosis was 72%,the specificity was 80%;and three accuracy for the diagnosis of sarcoidosis had no difference.It is better to combination IL-22 and SACE to diognosis sarcoidosis,a sensitivity of 88% and a specificity of 100%.4.3 patients received glucocorticoid therapy,serum IL-22 levels were significantly come down after treatment.Conclusion1.SACE is the most commonly used biomarkers for diagnosis of sarcoidosis.2.IL-22 and IgA may be used as the new biomarkers for diagnosis of sarcoidosis.3.IL-22 combined with SACE can improve the sensitivity of diagnosis of sarcoidosis.4.IL-22 may be used as biomarkers for monitoring the effects of treatment of sarcoidosis.