SARKOÝDOZ: TANI, TEDAVÝ VE TAKÝPTE 20 YILLIK DENEYÝM

Amaç: Sarkoidoz, sebebi bilinmeyen, birden fazla sistemi tutan, granülomatöz bir hastalýktýr. Taný koyma aþamalarý, uzun ve kýsa süreli takibi günlük pratikte uðraþtýrýcýdýr ve deneyim gerektirir. Çalýþmamýzda kliniðimizde 20 yýldýr takip ettiðimiz sarkoidoz olgularýnýn, taný, tedavi ve takip sonuçlarý incelenmiþtir. Yöntem ve Gereç: Çalýþmamýzda 1994-2014 yýllarý arasýnda 3. basamak göðüs hastalýklarý kliniðinde takip edilmekte olan sarkoidoz olgularýnýn demografik özellikleri, ilk baþvuru þikâyetleri, tüberkülin cilt testi, biyokimyasal parametreleri, radyolojik özellikleri, evreleri, solunum fonksiyon testi ve DLCO ölçümleri, taný, tedavi ve uzun /kýsa dönem takip sonuçlarý deðerlendirildi. Bulgular: 338 hastanýn 241’i (%71,3) kadýn, 97’si (%28,7) erkek idi. Hastalarýn taný sýrasýndaki yaþ ortalamasý 42,6±11,6 (17-75) idi. Hastalarýmýzýn 48’inin (%14,2) sarkoidoz tanýsý klinik, laboratuvar ve radyolojik bulgularla konulurken diðer hastalarda invaziv giriþimler yapýldýðý görüldü. En sýk kullanýlan invaziv yöntemler transbronþiyal biyopsi (%42,6), mediastinoskopi veya transbronþiyal biyopsi (sýrasýyla %40,8 ve %13,9) ve bronþ mukoza biyopsisi (forceps biyopsi) (%35,2) idi. Hastalarýn 262’sinin (%75,6) tedavisiz izlendiði, 76’sine (%22,4) deðiþik dönemlerde tedavi verildiði görüldü. Hastalarýn 22’sinde (%6,2) taný sonrasý dönemde relaps olduðu görüldü. Tedavi verilmeden izlenen ve tedavi verilen hastalarda relaps gözlenme oranlarýnýn sýrasýyla 3 hasta (%2,5) ve 19 hasta (%42) olduðu görüldü (p<0,01). Sonuç: Farklý organlarý tutan ve farklý klinik prezentasyonlarý olan bu hastalýk, büyük oranda spontan remisyonla seyreder. Ancak ileri evre hastalýkta mortalite ve morbidite fazladýr. Ayrýca çalýþmamýzda da gördüðümüz gibi ileri evre hastalarda tedavi almalarýna raðmen relaps sýklýðý fazladýr. Klinik pratikte sarkoidoz olgularýnýn tanýsýnýn erken konarak yakýn takip edilmesi ve ileri evre hastalarýn relaps, mortalite ve morbidite açýsýndan yakýn takibi büyük önem taþýmaktadýr.

SARCOIDOSIS: 20 YEARS OF EXPERIENCE IN DIAGNOSIS, TREATMENT AND FOLLOW-UP

Aim: Sarcoidosis is a granulomatous disease with unknown origin. Long and short-term follow-up and diagnosis of sarcoidosis are challenging in daily practice and require experience. In our study, the diagnosis, treatment and follow-up results of patients with sarcoidosis followed for 20 years were examined. Material and method: Sarcoidosis patients followed in tertiary chest diseases clinic between 1994-2014 were evaluated. Demographic features, referral complaints, tuberculin skin test, biochemical parameters, radiological features, PFT and DLCO measurements, diagnosis, treatment, long-short term follow-up results were evaluated. Results: Of the 338 patients, 241 (71.3%) were female. The mean age at the time of diagnosis was 42.6±11.6 (17-75) years. While 48 (14.2%) patients were diagnosed based on clinical, laboratory and radiological findings, invasive procedures were performed to the rest. The most commonly used invasive methods were transbronchial biopsy (42.6%), mediastinoscopy or transbronchial biopsy (40.8% and 13.9%, respectively) and bronchial mucosal biopsy (forceps biopsy) (35.2%). 262 (75.6%) of the patients were followed without treatment and 76 (22.4%) were treated in different periods. 22 (6.2%) patients had relapse in the postdiagnosis period. The patients followed-up without and with treatment, relapse rates were 3 patients (2.5%) and 19 patients (42%), respectively (p <0.01). Conclusion: Sarcoidosis affects different organs and has different clinical presentations; besides spontaneous remission is occurred in the most of patient. However, mortality and morbidity are high in advanced disease. As determined in present study frequency of relapse is high in patients with advanced stage. Early diagnosis of sarcoidosis, close follow-up of patients with advanced disease in terms of relapse, mortality and morbidity, are important in clinical practice.