结节病伴乳糜胸一例并文献复习_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

李南 ¹ , 王继旺 ¹ , 朱岩 ² ,  金淑贤 ¹

1. ;
2. ;

Corresponding author：

金淑贤, Email: jin_sx@aliyun.com

Keywords：

结节病; 乳糜胸; 肉芽肿; 治疗

DOI：

10.7507/1671-6205.201905046

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目的观察分析结节病伴乳糜胸的临床特征、诊断、治疗，以提高临床医生对该病的认识。方法分析南京医科大学第一附属医院病理确诊的首例结节病伴乳糜胸患者的临床资料，并检索复习 PubMed 的 10 例结节病伴乳糜胸患者的发病年龄、性别、临床表现、实验室检查、治疗和预后。结论本例为年轻男性患者，以胸痛、咳嗽为首发症状；胸部 CT 示全身多发淋巴结肿大，多发肺结节影，胸膜增厚，左侧胸腔积液及肺间质改变；胸腔闭式引流示乳糜胸；颈部淋巴结和支气管黏膜活检病理为非干酪样肉芽肿；经泼尼松治疗 9 个月预后佳。分析检索的 10 例结节病并发乳糜胸患者，以右侧乳糜胸为主，患者大多通过肺组织、淋巴结及胸膜活检确诊，治疗包括糖皮质激素、生长抑素、中链甘油三脂饮食、胸膜固定术及胸导管结扎术。对Ⅱ、Ⅲ期患者以糖皮质激素为基础的内科治疗大多数预后良好，Ⅳ期结节病伴并乳糜胸患者糖皮质激素治疗效果差，并发心肺功能不全可致死亡。结论乳糜胸是结节病的一种罕见并发症，与肉芽肿侵犯淋巴组织引起淋巴管阻塞有关，内科治疗大多预后好。

Citation： 李南, 王继旺, 朱岩, 金淑贤. 结节病伴乳糜胸一例并文献复习. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(1): 49-53. doi: 10.7507/1671-6205.201905046 Copy

1.	Valeyre D, Prasse A, Nunes H, et al. Sarcoidosis. Lancet, 2014, 383(9923): 1155-1167.
2.	Huggins JT, Doelken P, Sahn SA, et al. Pleural effusions in a series of 181 outpatients with sarcoidosis. Chest, 2006, 129(6): 1599-1604.
3.	Kostina ZI, Ivanovskii VB, Voloshko IV. Diagnosis and treatment of pleural lesions in sarcoidosis of the respiratory organs. Problemy Tuberkuleza, 1992, (7-8): 21-23.
4.	Judson MA. The clinical features of sarcoidosis: a comprehensive review. Clin Rev Allergy Immunol, 2014, 49(1): 63-78.
5.	Walker S, Adamali H, Bhatt N, et al. Pleuroparenchymal sarcoidosis-A recognised but rare manifestation of disease. Respir Med Case Rep, 2018, 23: 110-114.
6.	Aberg H, Bah M, Waters AW. Sarcoidosis complicated by chylothorax. Minn Med, 1966, 49(7): 1065-1070.
7.	Haegeli A, Keller R. Chylothorax bei Sarkoidose. Schweiz Med Wochenschr, 1981, 111(4): 125-128.
8.	Regdosz R, Mulliez PH, Croxo C, et al. Association of sarcoidosis, Hodgkin’s lymphoma and chylothorax. Presse Med, 1984, 13(18): 1158.
9.	Cappell MS, Friedman D, Mikhail N. Chyloperitoneum associated with chronic severe sarcoidosis. Am J Gastroenterol, 1993, 88(1): 99-101.
10.	Parker JM, Torrington KG, Phillips YY. Sarcoidosis complicated by chylothorax. South Med J, 1994, 87: 860-862.
11.	Jarman PR, Whyte MK, Sabroe I, et al. Sarcoidosis presenting with chylothorax. Thorax, 1995, 50(12): 1324-1325.
12.	Lengyel RJ, Shanley DJ. Recurrent chylothorax associated with sarcoidosis. Hawaii Med J, 1995, 54(12): 817-818.
13.	Haitsch R, Frank W, Evers H, et al. Chylothorax as a complication of sarcoidosis. Pneumologie, 1996, 50(12): 912-914.
14.	Carlier ML, Roux JP, Perez T, et al. Chylothorax and sarcoidosis. Rev Mal Respir, 1997, 14(4): 315-317.
15.	Ferreiro L, San José E, González-Barcala FJ, et al. Pleural effusion and sarcoidosis: a rare association. Arch Bronconeumol, 2014, 50(12): 554-556.
16.	Bhattarai B, Schmidt F, Devkota A, et al. A case of chylothorax in a patient with sarcoidosis: a rare and potentially fatal complication. J Community Hosp Intern Med Perspect, 2015, 5(4): 28300.
17.	Gupta A, Utpat K, Desai U, et al. Chylothorax due to sarcoidosis: a unique occurrence. Lung India, 2019, 36(1): 87-89.
18.	Rubini G, Cappabianca S, Altini C, et al. Current clinical use of 18FDG-PET/CT in patients with thoracic and systemic sarcoidosis. La Radiologia Medica, 2014, 119(1): 64-74.
19.	Braun JJ, Kessler R, Constantinesco A, et al. 18F-FDG PET/CT in sarcoidosis management: review and report of 20 cases. Eur J Nucl Med Mol Imaging, 2008, 35(8): 1537-1543.
20.	Keijsers RG, Verzijlbergen EJ, van den Bosch JM, et al. 18F-FDG PET as a predictor of pulmonary function in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis, 2011, 28(2): 123-129.
21.	Keijsers RG, van den Heuvel DA, Grutters JC. Imaging the inflammatory activity of sarcoidosis. Eur Respir J, 2013, 41(3): 743-751.

1. Valeyre D, Prasse A, Nunes H, et al. Sarcoidosis. Lancet, 2014, 383(9923): 1155-1167.
2. Huggins JT, Doelken P, Sahn SA, et al. Pleural effusions in a series of 181 outpatients with sarcoidosis. Chest, 2006, 129(6): 1599-1604.
3. Kostina ZI, Ivanovskii VB, Voloshko IV. Diagnosis and treatment of pleural lesions in sarcoidosis of the respiratory organs. Problemy Tuberkuleza, 1992, (7-8): 21-23.
4. Judson MA. The clinical features of sarcoidosis: a comprehensive review. Clin Rev Allergy Immunol, 2014, 49(1): 63-78.
5. Walker S, Adamali H, Bhatt N, et al. Pleuroparenchymal sarcoidosis-A recognised but rare manifestation of disease. Respir Med Case Rep, 2018, 23: 110-114.
6. Aberg H, Bah M, Waters AW. Sarcoidosis complicated by chylothorax. Minn Med, 1966, 49(7): 1065-1070.
7. Haegeli A, Keller R. Chylothorax bei Sarkoidose. Schweiz Med Wochenschr, 1981, 111(4): 125-128.
8. Regdosz R, Mulliez PH, Croxo C, et al. Association of sarcoidosis, Hodgkin’s lymphoma and chylothorax. Presse Med, 1984, 13(18): 1158.
9. Cappell MS, Friedman D, Mikhail N. Chyloperitoneum associated with chronic severe sarcoidosis. Am J Gastroenterol, 1993, 88(1): 99-101.
10. Parker JM, Torrington KG, Phillips YY. Sarcoidosis complicated by chylothorax. South Med J, 1994, 87: 860-862.
11. Jarman PR, Whyte MK, Sabroe I, et al. Sarcoidosis presenting with chylothorax. Thorax, 1995, 50(12): 1324-1325.
12. Lengyel RJ, Shanley DJ. Recurrent chylothorax associated with sarcoidosis. Hawaii Med J, 1995, 54(12): 817-818.
13. Haitsch R, Frank W, Evers H, et al. Chylothorax as a complication of sarcoidosis. Pneumologie, 1996, 50(12): 912-914.
14. Carlier ML, Roux JP, Perez T, et al. Chylothorax and sarcoidosis. Rev Mal Respir, 1997, 14(4): 315-317.
15. Ferreiro L, San José E, González-Barcala FJ, et al. Pleural effusion and sarcoidosis: a rare association. Arch Bronconeumol, 2014, 50(12): 554-556.
16. Bhattarai B, Schmidt F, Devkota A, et al. A case of chylothorax in a patient with sarcoidosis: a rare and potentially fatal complication. J Community Hosp Intern Med Perspect, 2015, 5(4): 28300.
17. Gupta A, Utpat K, Desai U, et al. Chylothorax due to sarcoidosis: a unique occurrence. Lung India, 2019, 36(1): 87-89.
18. Rubini G, Cappabianca S, Altini C, et al. Current clinical use of 18FDG-PET/CT in patients with thoracic and systemic sarcoidosis. La Radiologia Medica, 2014, 119(1): 64-74.
19. Braun JJ, Kessler R, Constantinesco A, et al. 18F-FDG PET/CT in sarcoidosis management: review and report of 20 cases. Eur J Nucl Med Mol Imaging, 2008, 35(8): 1537-1543.
20. Keijsers RG, Verzijlbergen EJ, van den Bosch JM, et al. 18F-FDG PET as a predictor of pulmonary function in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis, 2011, 28(2): 123-129.
21. Keijsers RG, van den Heuvel DA, Grutters JC. Imaging the inflammatory activity of sarcoidosis. Eur Respir J, 2013, 41(3): 743-751.

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结节病伴乳糜胸一例并文献复习

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