以多顱神經病變起病繼發多器官受累的結節病一例_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

莫欣悅 , 韓文雅 ,  王梅芳 ,  唐以軍

湖北醫藥學院附屬十堰市太和醫院（湖北十堰 442000）;

Corresponding?author：

王梅芳, Email: wmfpps02@hotmail.com; 唐以軍, Email: tangyijun_799@163.com

Keywords：

結節病; 間質性肺病; 多顱神經病變; 多器官受累

DOI：

10.7507/1671-6205.202412016

Video：

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目的報告1例多顱神經病變繼發多器官受累的結節病患者的診療過程，結合國內外相關文獻進行分析，加強臨床醫師對該疾病的認識及重視，提高早診早治率，減少漏診及誤診。方法對1例多顱神經病變繼發多器官受累的結節病患者的臨床資料結合國內外文獻進行分析和總結。結果 1例因“視物模糊、口角歪斜、長期咳嗽咳痰”多次入院的51歲女性患者，結合臨床癥狀、體征、影像學特點及病理檢查，診斷為結節病，治療后隨訪癥狀好轉。結論對于臨床上遇到多個系統癥狀短期內接連發生并因此多次住院患者，常規對癥治療效果不佳且病情仍在不斷進展并排除其他相關疾病時，應考慮受累非典型系統的結節病可能，同時也為結節病的治療提供臨床策略。

Citation： 莫欣悅, 韓文雅, 王梅芳, 唐以軍. 以多顱神經病變起病繼發多器官受累的結節病一例. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(5): 351-355. doi: 10.7507/1671-6205.202412016 Copy

1.	Arkema EV, Cozier YC. Sarcoidosis epidemiology: recent estimates of incidence, prevalence and risk factors. Curr Opin Pulm Med, 2020, 26(5): 527-534.
2.	陳相, 李耀浙, 傅揚揚等. 1990-2019年中國間質性肺疾病和肺結節病的疾病負擔分析. 疾病監測, 2023, 38(4): 473-480.
3.	Fritz D, van de Beek D, Brouwer MC. Clinical features, treatment and outcome in neurosarcoidosis: systematic review and meta-analysis. BMC Neurol, 2016, 16(1): 220.
4.	Suresh S, Kosmorsky GS, Lee MS. Isolated optic nerve sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis, 2017, 34(2): 179-183.
5.	Stern BJ, Royal W 3rd, Gelfand JM, et al. Definition and Consensus Diagnostic Criteria for Neurosarcoidosis: From the Neurosarcoidosis Consortium Consensus Group. JAMA Neurol, 2018, 75(12): 1546-1553.
6.	段曼曼, 于世榮, 朱學娥, 等. 伴有眼部癥狀的皮下結節型結節病一例. 中國麻風皮膚病雜志, 2023, 39(7): 521-523.
7.	張倩, 黃慧, 徐作軍. 肺結節病的診治進展. 臨床內科雜志, 2020, 37(10): 684-688.
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12.	中華醫學會呼吸病學分會間質性肺疾病學組, 中國醫師協會呼吸醫師分會間質性肺疾病工作委員會, 等. 中國肺結節病診斷和治療專家共識. 中華結核和呼吸雜志, 2019, 42(9): 685-693.
13.	Leonhard SE, Fritz D, Eftimov F, et al. Neurosarcoidosis in a tertiary referral center: a cross-sectional cohort study. Medicine (Baltimore), 2016, 95(14): e3277.
14.	Locke AH, Gurin MI, Sabe M, et al. Arrhythmia in cardiac sarcoidosis. Cardiol Rev, 2021, 29(3): 131-142.
15.	Niederer RL, Sims JL. Utility of screening investigations for systemic sarcoidosis in undifferentiated uveitis. Am J Ophthalmol, 2019, 206: 149-153.
16.	王秀燕, 高建梅, 張紅, 等. 以胸腔積液為首發表現的結節病四例. 中國呼吸與危重監護雜志, 2022, 21(3): 185-188.
17.	Leader JK, Warfel TE, Fuhrman CR, et al. Pulmonary nodule detection with low-dose CT of the lung: agreement among radiologists. AJR Am J Roentgenol, 2005, 185(4): 973-978.
18.	Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med, 2007, 357(21): 2153-2165.
19.	Grumet P, Kodjikian L, de Parisot A, et al. Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis). Autoimmun Rev, 2018, 17(4): 331-343.
20.	Niederer RL, Al-Janabi A, Lightman SL, et al. Serum angiotensin-converting enzyme has a high negative predictive value in the investigation for systemic sarcoidosis. Am J Ophthalmol, 2018, 194: 82-87.
21.	Kraaijvanger R, Janssen Bonás M, Vorselaars ADM, et al. Biomarkers in the Diagnosis and Prognosis of Sarcoidosis: Current Use and Future Prospects. Front Immunol, 2020, 11: 1443.
22.	Febvay C, Kodjikian L, Maucort-Boulch D, et al. Clinical features and diagnostic evaluation of 83 biopsy-proven sarcoid uveitis cases. Br J Ophthalmol, 2015, 99(10): 1372-1376.
23.	Bilgin B, Bilgin MK, Erol S, et al. Prognosis of sarcoidosis and factors affecting prognosis. Sarcoidosis Vasc Diffuse Lung Dis, 2023, 40(4): e2023054.
24.	龔金鋒, 黃光. 神經結節病研究進展. 武警醫學, 2018, 29(06): 638-642.
25.	Fahim A, Mann JS. Pulmonary sarcoidosis: diagnostic and treatment update. Expert Rev Respir Med, 2014, 8(4): 493-501.
26.	丁雁啟, 李合友, 袁雪芹. 結節病四例診治體會. 中國呼吸與危重監護雜志, 2016, 15(2): 176-178.
27.	El Jammal T, Jamilloux Y, Gerfaud-Valentin M, et al. Refractory sarcoidosis: a review. Ther Clin Risk Manag, 2020, 16: 323-345.

1. Arkema EV, Cozier YC. Sarcoidosis epidemiology: recent estimates of incidence, prevalence and risk factors. Curr Opin Pulm Med, 2020, 26(5): 527-534.
2. 陳相, 李耀浙, 傅揚揚等. 1990-2019年中國間質性肺疾病和肺結節病的疾病負擔分析. 疾病監測, 2023, 38(4): 473-480.
3. Fritz D, van de Beek D, Brouwer MC. Clinical features, treatment and outcome in neurosarcoidosis: systematic review and meta-analysis. BMC Neurol, 2016, 16(1): 220.
4. Suresh S, Kosmorsky GS, Lee MS. Isolated optic nerve sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis, 2017, 34(2): 179-183.
5. Stern BJ, Royal W 3rd, Gelfand JM, et al. Definition and Consensus Diagnostic Criteria for Neurosarcoidosis: From the Neurosarcoidosis Consortium Consensus Group. JAMA Neurol, 2018, 75(12): 1546-1553.
6. 段曼曼, 于世榮, 朱學娥, 等. 伴有眼部癥狀的皮下結節型結節病一例. 中國麻風皮膚病雜志, 2023, 39(7): 521-523.
7. 張倩, 黃慧, 徐作軍. 肺結節病的診治進展. 臨床內科雜志, 2020, 37(10): 684-688.
8. Rizzato G, Fraioli P, Montemurro L. Nephrolithiasis as a presenting feature of chronic sarcoidosis. Thorax. 1995, 50(5): 555-559.
9. Rodman JS, Mahler RJ. Kidney stones as a manifestation of hypercalcemic disorders. Hyperparathyroidism and sarcoidosis. Urol Clin North Am, 2000, 27(2): 275-285.
10. Kusano KF, Satomi K. Diagnosis and treatment of cardiac sarcoidosis. Heart, 2016, 102(3): 184-190.
11. Hamzeh N, Steckman DA, Sauer WH, et al. Pathophysiology and clinical management of cardiac sarcoidosis. Nat Rev Cardiol, 2015, 12(5): 278-288.
12. 中華醫學會呼吸病學分會間質性肺疾病學組, 中國醫師協會呼吸醫師分會間質性肺疾病工作委員會, 等. 中國肺結節病診斷和治療專家共識. 中華結核和呼吸雜志, 2019, 42(9): 685-693.
13. Leonhard SE, Fritz D, Eftimov F, et al. Neurosarcoidosis in a tertiary referral center: a cross-sectional cohort study. Medicine (Baltimore), 2016, 95(14): e3277.
14. Locke AH, Gurin MI, Sabe M, et al. Arrhythmia in cardiac sarcoidosis. Cardiol Rev, 2021, 29(3): 131-142.
15. Niederer RL, Sims JL. Utility of screening investigations for systemic sarcoidosis in undifferentiated uveitis. Am J Ophthalmol, 2019, 206: 149-153.
16. 王秀燕, 高建梅, 張紅, 等. 以胸腔積液為首發表現的結節病四例. 中國呼吸與危重監護雜志, 2022, 21(3): 185-188.
17. Leader JK, Warfel TE, Fuhrman CR, et al. Pulmonary nodule detection with low-dose CT of the lung: agreement among radiologists. AJR Am J Roentgenol, 2005, 185(4): 973-978.
18. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med, 2007, 357(21): 2153-2165.
19. Grumet P, Kodjikian L, de Parisot A, et al. Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis). Autoimmun Rev, 2018, 17(4): 331-343.
20. Niederer RL, Al-Janabi A, Lightman SL, et al. Serum angiotensin-converting enzyme has a high negative predictive value in the investigation for systemic sarcoidosis. Am J Ophthalmol, 2018, 194: 82-87.
21. Kraaijvanger R, Janssen Bonás M, Vorselaars ADM, et al. Biomarkers in the Diagnosis and Prognosis of Sarcoidosis: Current Use and Future Prospects. Front Immunol, 2020, 11: 1443.
22. Febvay C, Kodjikian L, Maucort-Boulch D, et al. Clinical features and diagnostic evaluation of 83 biopsy-proven sarcoid uveitis cases. Br J Ophthalmol, 2015, 99(10): 1372-1376.
23. Bilgin B, Bilgin MK, Erol S, et al. Prognosis of sarcoidosis and factors affecting prognosis. Sarcoidosis Vasc Diffuse Lung Dis, 2023, 40(4): e2023054.
24. 龔金鋒, 黃光. 神經結節病研究進展. 武警醫學, 2018, 29(06): 638-642.
25. Fahim A, Mann JS. Pulmonary sarcoidosis: diagnostic and treatment update. Expert Rev Respir Med, 2014, 8(4): 493-501.
26. 丁雁啟, 李合友, 袁雪芹. 結節病四例診治體會. 中國呼吸與危重監護雜志, 2016, 15(2): 176-178.
27. El Jammal T, Jamilloux Y, Gerfaud-Valentin M, et al. Refractory sarcoidosis: a review. Ther Clin Risk Manag, 2020, 16: 323-345.

Chinese Journal of Respiratory and Critical Care Medicine

以多顱神經病變起病繼發多器官受累的結節病一例

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