[Predictive value of single and combined indexes in the diagnosis of sarcoidosis].

OBJECTIVE: To evaluate the predictive value of single and combined indexes in the diagnosis of sarcoidosis. METHODS: Eighty-eight patients suspected of having sarcoidosis were retrospectively investigated. The diagnostic predictive value of lymphocyte percentage and CD4/CD8 ratio in bronchoalveolar lavage (BAL), angiotensin converting enzyme (ACE) and their combination was evaluated by ROC curve method and Bayes' rule. RESULTS: Final diagnosis of sarcoidosis by biopsy was available in 59 patients (67%), 16 were males (27%), 43 were females (73%), with a mean age of (48 +/- 10) years. The diagnosis of non-sarcoidosis was available in 29 patients (33%), 12 were males (41%), 17 were females (59%), with a mean age of (49 +/- 13) years. The ROC curve area of lymphocyte percentage, CD4/CD8 ratio and ACE were 0.64, 0.74 and 0.69 respectively; CD4/CD8 ratio had the best diagnostic efficiency. The optimized cut-offs of the three single indexes, lymphocyte percentage > or = 30%, CD4/CD8 ratio > or = 4.0 and ACE > or = 40 U/L, were determined by the tangential points and coordinates of the ROC curve. The positive predictive values were 76.7%, 80.4% and 76.8% respectively; CD4/CD8 ratio had the best predictive value. The ROC curve area of the combined CD4/CD8 ratio and ACE was 0.81, and the combination of lymphocyte percentage, CD4/CD8 ratio and ACE was 0.78. They were both higher than those of the respective single indexes. The combination of CD4/CD8 ratio and ACE had the best diagnostic efficiency. On the other hand, it had the best positive predictive value of 90.5% in all the diagnostic indexes. CONCLUSION: CD4/CD8 ratio in BAL is still a useful index in the auxiliary diagnosis of sarcoidosis. The combination of CD4/CD8 ratio and ACE can improve the diagnostic efficiency and predictive value of sarcoidosis.

[Analysis of the treatment and prognosis of 59 patients with sarcoidosis].

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.