[Analysis of the treatment and prognosis of 59 patients with sarcoidosis].
OBJECTIVE
To investigate the relationship between clinical characteristics, treatment and prognosis of sarcoidosis, and to analyze the factors for disease severity and prognosis.


METHODS
Retrospective analysis of 59 patients with sarcoidosis admitted to Peking Union Medical College Hospital from January 1984 to January 2003, with a follow-up for at least 24 months.


RESULTS
The mean follow-up period was (61.9 +/- 49.4) months. All of the 7 patients with stage 0 accepted glucocorticoid therapy and responded well, and 4 of them completely remitted. Among 22 cases with stage I disease, 4 underwent spontaneous remission while another one who had extra-pulmonary sarcoidosis at the onset progressed after follow-up for 6 months. Seventeen cases were treated with glucocorticoids after the diagnosis was confirmed. Before this study, 9 patients had experienced complete remission, and 7 had been stable disease respectively, while one had progressed to stage II. Twenty-two of the 23 stage II patients received glucocorticoids initially and one was treated after an observation period of 3 months before deterioration. Thirteen patients of stage II were completely cured, and 2 were still progressing under the drug therapy. All of the 5 patients in stage III accepted glucocorticoids after diagnosis. One of the 5 patients has resolved completely and 2 had progressed into stage IV. The interstitial changes of the lung in 2 stage IV patients had been progressing even though the treatment lasted for years. There were no significant differences in the serum angiotensin converting enzyme (ACE) level, total broncho-alveolar fluid (BALF) cell count, percentage of alveolar lymphocytes, neutrophils and lymphocyte CD(4)/CD(8) ratio at the onset between stage I and stage II diseases. Age, gender, presence of respiratory symptom, serum ACE level, total BALF cell count, percentage of alveolar lymphocytes, neutrophils or lymphocyte CD(4)/CD(8) ratio at the onset were not associated with relapse. 14 cases relapsing pulmonary sarcoidosis had extra-pulmonary lesions, and there was a close correlation between the relapse and extra-pulmonary lesions (P = 0.006). A significant increase in the percentage of BALF neutrophils (8.37 +/- 3.55)% at the time of diagnosis was observed in patients who had not completely resolved as compare with the patients who had recovered [(3.52 +/- 2.37)%, P < 0.001].


CONCLUSIONS
The outcome of sarcoidosis are generally good. Patients with extra-pulmonary sarcoidosis are more likely to experience relapse. Stage I disease should receive observation before glucocorticoid therapy. Increased percentage of neutrophils in BALF at the onset is possibly associated with a progressive or persistent disease.
Ding
Ke
K
Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Xu
Zuo-jun
ZJ
Huang
Hui
H
Lu
Wei-xuan
WX
Luo
Wei-ci
WC
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000188:drug therapy*
D005938:Glucocorticoids