| OBJECTIVE: The clinical characteristics of sarcoidosis and the therapeutic effect of glucocorticoids were summarized and analyzed to find out the factors affecting the recurrence of sarcoidosis and further improve the understanding and treatment experience of sarcoidosis.METHODS: The clinical data of patients with sarcoidosis admitted to the Second Hospital of Jilin University from January 2009 to October 2018 were retrospectively analyzed.The data included gender,age,past history,clinical symptoms,imaging findings,laboratory tests,and lungs.The function,treatment plan and dosage,and telephone follow-up were used to evaluate the efficacy.Statistical analysis of the above data to identify factors affecting patient recurrence.The data were processed by SPSS 23.0,and p < 0.05 was considered statistically significant.RESULTS: A total of 68 patients were enrolled in the study,including 21 males and 47 females.The female incidence rate was 2.32 times that of males.The average age was 47.03±9.21 years old,70.59%(48/68)patients were in the 40-59 age group,4 patients had a history of tuberculosis,and 16 patients had a history of exposure to smoke/special chemicals.The main clinical symptoms were respiratory symptoms(83.8%),systemic non-specific symptoms(38.3%)and extrapulmonary lymphadenopathy(32.4%).Other rare clinical symptoms were nasal congestion and nasal mass,thrombocytopenia and splenomegaly.51.5%(35/54)of patients were involved in single organ system involvement.Typical imaging findings of sarcoidosis are mediastinal lymphadenopathy with(or without)bilateral hilar enlargement,mediastinal unilateral hilar enlargement and simple unilateral hilar enlargement are rare,and pleural effusion in stage II patients.And the pleural involvement was more than the I stage.In this study,hypercalcemia and abnormal calcium and phosphorus metabolism were not found.ESR,C-reactive protein and immunoglobulin were abnormal in different degrees and were not related to staging(p>0.05).In this study,16 patients completed lung ventilation function and diffusion function measurement,only 12.5%(2/16)no abnormalities.A total of 54 patients were followed up in this study,and 14 patients were lost to follow-up.The follow-up time was 3-130 months with a median of 32 months.Seven patients were clinically observed,and 47 patients were treated with glucocorticoids.They were divided into venous shock group and oral maintenance group according to the dose.The efficacy of all patients was evaluated.There were 8 patients with complete remission,39 patients with partial remission,6 patients with recurrence,and 1 patient with ineffectiveness.The prognosis of patients with stage III was better,and one patient with stage IV died.All the 6 relapsed patients had imaging progress,and 4 patients had clinical symptoms aggravating.The symptoms were the same as those at the initial diagnosis.After glucocorticoid treatment,all patients had symptoms and imaging improvement.The recurrence time was as short as 5 months and as long as 113 months.The relationship between recurrence and age,sex,contact history,site of involvement,clinical symptoms,imaging changes,treatment and dosage regimen was analyzed.Single and multivariate logistic analysis,Kaplan-Meier survival curve analysis and univariate COX analysis were performed for each factor.Age and treatment were found to be the two factors influencing recurrence after controlling age variables.The risk of recurrence in untreated patients was 12.433 times higher than that in untreated patients.After controlling whether the treatment variable was available,the risk of recurrence increased by 1.142 times for each age increase.CONCLUSION:1.Sarcoidosis is most common in the 40-59 age group.The incidence rate of female is 2.32 times that of male.2.The main clinical symptoms of sarcoidosis are respiratory symptoms,non-specific systemic symptoms with enlarged extrapulmonary lymph nodes.Cough and sputum are the main symptoms.Other rare symptoms include splenomegaly,thrombocytopenia and nasal mass.About 50% are single organ involvement.3.Mediastinum with bilateral hilar lymph node enlargement is a common imaging change.? period patients see more changes in the lungs is nodular shadows.4.Pulmonary function is impaired to varying degrees in patients with sarcoidosis.5.In this study,there was no elevation of serum calcium in sarcoidosis patients.Alkaline phosphatase,erythrocyte sedimentation rate,C-reactive protein,anti-nuclear antibody spectrum and immunoglobulin were abnormal in varying degrees,which were not related to stage.6.In this study,the recurrence rate of sarcoidosis was 11.1%.After glucocorticoid treatment,the symptoms and imaging of recurrent sarcoidosis were improved.In the analysis of the relationship between recurrence and age,sex,contact history,site of involvement,clinical symptoms,imaging changes,treatment and dose regimen,age and glucocorticoid treatment were the factors influencing recurrence of sarcoidosis.The older the patients are treated,the higher the risk of recurrence.For the same age,the risk of recurrence in the treated patients is lower than that in the untreated patients. |
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