Objective: To investigate the relationship between clinical characteristics, treatment and prognosis of sarcoidosis, and to analyze the factors for disease severity and prognosis.
Method: Retrospective analysis of 59 patients with sarcoidosis admitted to Peking Union Medical College Hospital from January 1984 to January 2003, with a follow-up for at least 24 months.
Results: The mean follow-up period was (61.9 +/- 49.4) months. All of the 7 patients with stage 0 accepted glucocorticoid therapy and responded well, and 4 of them completely remitted. Among 22 cases with stage I disease, 4 underwent spontaneous remission while another one who had extra-pulmonary sarcoidosis at the onset progressed after follow-up for 6 months. Seventeen cases were treated with glucocorticoids after the diagnosis was confirmed. Before this study, 9 patients had experienced complete remission, and 7 had been stable disease respectively, while one had progressed to stage II. Twenty-two of the 23 stage II patients received glucocorticoids initially and one was treated after an observation period of 3 months before deterioration. Thirteen patients of stage II were completely cured, and 2 were still progressing under the drug therapy. All of the 5 patients in stage III accepted glucocorticoids after diagnosis. One of the 5 patients has resolved completely and 2 had progressed into stage IV. The interstitial changes of the lung in 2 stage IV patients had been progressing even though the treatment lasted for years. There were no significant differences in the serum angiotensin converting enzyme (ACE) level, total broncho-alveolar fluid (BALF) cell count, percentage of alveolar lymphocytes, neutrophils and lymphocyte CD(4)/CD(8) ratio at the onset between stage I and stage II diseases. Age, gender, presence of respiratory symptom, serum ACE level, total BALF cell count, percentage of alveolar lymphocytes, neutrophils or lymphocyte CD(4)/CD(8) ratio at the onset were not associated with relapse. 14 cases relapsing pulmonary sarcoidosis had extra-pulmonary lesions, and there was a close correlation between the relapse and extra-pulmonary lesions (P = 0.006). A significant increase in the percentage of BALF neutrophils (8.37 +/- 3.55)% at the time of diagnosis was observed in patients who had not completely resolved as compare with the patients who had recovered [(3.52 +/- 2.37)%, P < 0.001].
Conclusion: The outcome of sarcoidosis are generally good. Patients with extra-pulmonary sarcoidosis are more likely to experience relapse. Stage I disease should receive observation before glucocorticoid therapy. Increased percentage of neutrophils in BALF at the onset is possibly associated with a progressive or persistent disease.