Povezanost bronhoskopske, kliničke i radiološke dijagnostike kod obolelih od sarkoidoze

Abstract

Uvod: Sarkoidoza je multisistemska bolest nepoznate etiologije koja se karakteriše prisustvom nekazeifikujućih granuloma u tkivima i organima. Složena patogenetska osnova sarkoidoze uslovljava nepostojanje jedinstvenog dijagnostičkog testa za sarkoidozu. Neophodno je utrditi koja dijagnostička metoda i na koji način najbolje odražava tok bolesti, i koji bi od kliničkih parametara najbolje to mogli da predvide. Materijal i metode: Opservacijsko (deskriptivno) kliničko istraživanje (studija preseka) obavljeno je u Klinici za pulmologiju Kliničkog centra Srbije. Prospektivnom analizom je obuhvaćen uzorak od 571 bolesnika sa bronhoskopski i histološki verifikovanom sarkoidozom. Svim bolesnicima je uzeta detaljna anamneza sa procenom kliničkih simptoma, urađena radiografija grudnog koša i laboratorijske analize, kao i bronhoskopija sa biopsijom. Dobijeni rezultati su kodirani, uneti u bazu podataka i analizirana je statistička povezanost pojedinih varijabli laboratorijskih, kliničkih, radiografskih i endoskopskih karakteristika sarkoidoze. Cilj ispitivanja bio je utvrditi povezanost kliničkih, radiografskih i bronhoskopskih nalaza kod obolelih od sarkoidoze, u cilju procene kliničkog toka i aktivnosti bolesti. Rezultati: Bilo je više žena (66,1%) nego muškaraca (33,9%). Odnos polova iznosio je 1,94 u korist žena. Kod većine bolesnika sa plućnom sarkoidozom dominantni simptomi i znaci su bili: suv i uporan kašalj (501-88,2%), promene na koži (564-98,8%) Najveći broj bolesnika je bio u prvom stadijumu bolesti, a najmanje ih je bilo u trećem i četvrtom stadijumu. Kod muškaraca je registrovana statistički značajno veća aktivnost angiotenzin konvertujućeg enzima (ACE) i hitotriozidaze. Visoko je statistički značajna razlika u aktivnosti hitotriozidaze u serumu između bolesnika sa aktivnom i neaktivnom sarkoidozom...

Introduction. Sarcoidosis is a multisystemic disease of unknown aetiology which is characterized by presence of non-caseating granulomas in various tissues and organs. Complex pathogenetic basis of the sarcoidosis is causing non existence of unique diagnostic test for sarcoidosis. It is necessary to determine which diagnostic test and in what way reflects the course of the disease and which of the clinical parametars are the best in its prediction. Matherial and methods. Observational (descriptive) clinical study (crosssectional study) was performed in Clinic for Pulmonary Diseases of Clinical Center of Serbia. The prospective analysis included 571 patient with bronchoscopically and histopathologically verified sarcoidosis. In all patients, detailed anamnesis was taken, with assessment of clinical symptoms, then chest radiography and laboratory analyses, as well as bronchoscopy with biopsy. Results were coded, entered into database and statistical significance of correlation between variableslaboratory, clinical, radiographic and endoscopic findings-was analyzed with appropriate statistical tests. Results. There were more women (66.1%) then men (33.9%). Gender ratio was 1.94 in favor of women. In most patients with pulmonary sarcoidosis dominat symptoms and signs were: dry, persistent cough (in 501 patient-88.2%) and skin changes (in 564 patients-98.8%). Most of the patients were in the first stage of the disease and much less in the third and fourth stage. Statistically significantly higher activity of both angiotensine-converting enzyme (ACE) and chitotriosidase in serum was noticed in men. Highly statistically significant is the difference in serum chitotriosidase activity between patients with active and inactive sarcoidosis. Serum ACE activity is also statistically significantly different between patients with active and inactive disease. The highest chitotriosidase activity is verified in patients in the second radiographic stage of sarcoidosis...