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结节病

最后审阅: 10 Nov 2024
最后更新: 11 Jul 2024

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 咳嗽
  • 呼吸困难
  • 慢性疲劳
  • 关节痛
  • 哮鸣音
  • 干啰音
  • 淋巴结肿大
  • 畏光
  • 痛性红眼
  • 视力模糊
  • 结节性红斑
  • 冻疮样狼疮
  • 结膜结节
  • 面神经麻痹
完整详情

其他诊断因素

  • 没有铍暴露史
  • 胸壁痛
  • 咯血
  • 体重减轻
  • 低热
  • 心律失常
  • 心脏传导阻滞
  • 肝肿大
  • 头痛
  • 惊厥
  • 垂体损害的症状和征象
完整详情

危险因素

  • 20-50 岁
  • 结节病家族史
  • 斯堪的纳维亚人
  • 女性
  • 非吸烟者
  • 黑人血统
  • 黑人裔:葡萄膜炎
  • 波多黎各血统:冻疮样狼疮
  • 欧洲血统:结节性红斑
完整详情

诊断性检查

首要检查

  • 胸部 X 线检查
  • 全血细胞计数 (FBC)
  • 血清尿素
  • 血清肌酐
  • 肝酶
  • 血清钙
  • 肺功能检测 (PFT)
  • 心电图 (ECG)
  • 眼部检查
  • γ 干扰素释放试验
完整详情

需考虑的检查

  • 血清 ACE 水平
  • 胸部 CT 扫描
  • 支气管内超声-经支气管针吸活组织检查术
  • 支气管肺泡灌洗 (bronchoalveolar lavage, BAL)
  • 皮肤活检
  • 24 小时尿钙
  • 镓-67 扫描
  • 维生素 D
  • 核磁共振成像 (MRI)
  • (18)F-氟脱氧葡萄糖 (FDG) PET 扫描
完整详情

新兴检查

  • 3′-脱氧-3′-[18F]-氟胸苷(FLT)PET 扫描
  • 4'-[甲基-11C]-硫代胸苷 PET/CT 扫描

治疗流程

急症处理

对口服不耐受的急性呼吸衰竭

对口服耐受的急性呼吸衰竭

持续性治疗

肺部疾病

皮肤病

眼部疾病

心血管疾病

中枢神经系统或周围神经系统受累

肾脏疾病

撰稿人

作者

Muthiah P. Muthiah, MD, FCCP

Acting Chief of Pulmonary, Critical Care & Sleep Medicine

VA Medical Center, Memphis

Professor & Vice Chair of Medicine

University of Tennessee Health Science Center

Memphis

TN

利益声明

MPM declares that he has no competing interests.

Amr El Gamal, MD, FCCP

Pulmonary and Critical Care

Medical Service

VA Medical Center

Martinsburg

Assistant Professor of Medicine

West Virginia University

Morgantown

WV

利益声明

AEG declares that he has served as a reviewer for the American Physician Institute.

同行评议者

George Swingler, MD

Professor

School of Child and Adolescent Health

Red Cross Children's Hospital

University of Cape Town

Rondebosch

Cape Town

South Africa

利益声明

GS declares that he has no competing interests.

Kyle Hogarth, MD, FCCP

Assistant Professor of Medicine

Department of Medicine

Section of Pulmonary and Critical Care

University of Chicago

Chicago

IL

利益声明

KH declares that he has no competing interests.

Marc Judson, MD

Chief

Division of Pulmonary and Critical Care Medicine

AMC Pulmonary and Critical Care Medicine

Albany

NY

利益声明

MJ declares that he has no competing interests.

Nadera Sweiss, MD

Assistant Professor of Medicine

Section of Rheumatology

Department of Medicine

University of Chicago

Chicago

IL

利益声明

NS declares that she has no competing interests.

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