Clinical features and diagnostic evaluation of 83 biopsy-proven sarcoid uveitis cases
Clinical features and diagnostic evaluation of 83 biopsy-proven sarcoid uveitis cases
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DOI：
10.1136/bjophthalmol-2014-306353
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发表时间：
2015-10-01
影响因子：
4.1
通讯作者：
Seve, Pascal
中科院分区：
文献类型：
--
作者：
Febvay, Camille;Kodjikian, Laurent;Seve, Pascal
目的确定葡萄膜炎伴活检证实的结节病患者的临床特征，根据种族、年龄和性别记录这些特征的差异，方法回顾性分析83例肝穿刺活检标本的临床资料，分析其生化及影像学检查的诊断价值。2004年4月至2014年3月在两个内科和两个眼科就诊的确诊结节病葡萄膜炎病例。结果白人患者出现葡萄膜炎的年龄比非白人患者晚（58岁vs 41岁; p=0.001），并且更常为慢性形式（78.3% vs 43.8%; p=0.01）。女性慢性黄斑水肿的发生率高于男性（48.3% vs 14.3%; p=0.01）。年龄50岁的患者之间无统计学显著差异。61.7%的患者ACE水平升高（>62 U/L），83.9%的患者溶菌酶水平升高（>16.7 mg/L）。胸部X线和CT分别提示结节病的62.8%和91.2%。在21例断层扫描阳性和X线阴性的患者中，13例为>50岁的白人女性。7例唇唾液腺正常的患者在超声内镜引导下细针抽吸胸内淋巴结并经支气管穿刺活检。任何的酶试验与任何的成像测试确定100%的patients.Conclusions在这一最大的欧洲系列活检证实结节病迄今为止，酶试验加成像测试夫妇的杰出诊断能力表明，诉诸侵入性程序应限于患者的眼部参与，将证明系统性治疗。
Aims To determine the clinical features of patients with uveitis with biopsy-proven sarcoidosis, document differences in these features according to ethnicity, age and sex, and assess the diagnostic value of biochemical and imaging examinations.Methods Retrospective study of 83 biopsy-proven sarcoid uveitis cases seen at two Departments of Internal Medicine and two Departments of Ophthalmology between April 2004 and March 2014.Results Caucasian patients presented with uveitis at a later age than non-Caucasian (58 years vs 41 years; p=0.001) and had more often a chronic form (78.3% vs 43.8%; p=0.01). Women had higher rates of chronic macular oedema than men (48.3% vs 14.3%; p=0.01). There were no statistically significant differences between patients aged 50 years. ACE levels were high (>62 U/L) in 61.7% and lysozyme levels high (>16.7 mg/L) in 83.9% of tested patients. Chest X-rays and CTs were suggestive of sarcoidosis in 62.8% and 91.2% of cases, respectively. Among 21 patients with positive tomography and negative X-rays, 13 were Caucasian women >50 years. Endoscopic ultrasound-guided fine-needle aspiration of intrathoracic nodes contributed to the diagnosis in 7 patients with normal labial salivary gland and transbronchial biopsies. Any of the enzyme tests together with any of the imaging tests identified 100% of the patients.Conclusions In this largest European series of biopsy-proven sarcoidosis to date, the outstanding diagnostic ability of enzyme test plus imaging test couple suggests that the recourse to invasive procedures should be limited to patients with ocular involvement that would justify systemic treatments.