Atilla Güven ATICI, Bilal ŞENGÜL, Levent ERKAN, Serhat FINDIK, Oğuz UZUN

Kliniğimizde interstisyel akciğer hastalığı tanısı alan 92 hastanın incelenmesi

Kliniğimizde interstisyel akciğer hastalığı tanısı alan 92 hastanın incelenmesi İnterstisyel akciğer hastalığı (İAH), birçok akut ve kronik akciğer hastalığını kapsamaktadır. Bu çalışmada, kliniğimizde İAH tanısı alan hastaları değerlendirmeyi amaçladık. 1 Ocak 2000-1 Ağustos 2004 tarihleri arasında toplam 92 hasta incelendi. Hastalarımızın 58 (%63)’i kadın, 34 (%37)’ü erkek olup, yaş ortalaması 50.2 ± 14.2 (19-80) idi. Kadınlar en sık olarak sarkoidoz tanısı alırken, erkeklerde en sık olarak idiyopatik pulmoner fibrozis (İPF) görüldü. En sık görülen üç hastalık; 36 (%39.1) hasta sarkoidoz, 33 (%35.9) hasta idiyopatik interstisyel pnömoni ve 13 (%14.1) hasta kollajen doku hastalığına bağlı akciğer tutulumu olarak tespit edildi. Tanı yöntemleri incelendiğinde; 36 (%39.1) hastaya klinik ve radyolojik yöntemle, 32 (%34.8) hastaya bronkoskopiyle, 10 (%10.9) hastaya mediastinoskopi ile 8 (%8.7) hastaya açık akciğer biyopsisiyle, 2 (%2.2) hastaya cilt biyopsisiyle, 1 (%1.1)’er hastaya oral mukoza biyopsisi, lenf nodu biyopsisi, böbrek biyopsisi ve plevral sıvı incelemesiyle tanı koyuldu. Sarkoidozlu hastaların %60.8’ine bronkoskopik yöntemle tanı koyuldu. İPF’li hastaların 12 (%48)’si toksik inhalasyonla ilişkili mesleklerde çalışıyordu. Tanı koyulan 80 hastaya tedavi başlandı. Sarkoidozlu ve kriptojenik organize pnömoni (KOP)’li hastalar tedaviye iyi yanıt verirken kollajen doku hastaları genelde stabil (11/13: %84.6) olarak seyretti. Sarkoidozlu bir hastada progresyon görüldü. İPF’li hastaların ise tedaviye yanıt oranının az (3: %15.7) olduğu görüldü. İPF’li hastalara şikayetler başladıktan ortalama 35.7 ay sonra tanı koyulduğu görüldü. İPF’li iki hastada eşlik eden akciğer kanseri tespit edildi. Tedaviye bağlı komplikasyonlar altı hastada görüldü. Ölen hastaların (n= 14) çoğunluğunu İPF’li hastalar (n= 8) oluşturuyordu. İAH nadir görülmeyen hastalıklar olup göğüs hastalıkları polikliniklerine başvuran hastaların ayırıcı tanısında daima göz önünde bulundurulmalıdır. Çalışmamızda literatürle uyumlu olarak en sık sarkoidoz ve İPF görülmüştür. İAH’de tanı koymada zorluklar olmakla birlikte klinik özellikler, radyolojik teknikler ve çeşitli biyopsi yöntemleriyle tanı koyulabilmektedir.

The evaluation of 92 interstitial lung disease patients

Interstitial lung diseases (ILD) include many acute and chronic pulmonary disorders. We aimed to evaluate the patients diagnosed as ILD in our clinic. Between January 2000 and August 2004, 92 patients were included in the study. Fifty eight (63%) of our patients were female, 34 (37%) were male and the median age was 50.2 ± 14.2 (19-80) years. The most frequent diagnoses were sarcoidosis in females, and IPF in males. The diagnostic methods used were as follows; clinically and radiologically in 36 (39.1%) patients, bronchoscopy in 33 (34.8%) patients, mediastinoscopy in 10 (10.9%) patients, open lung biopsy in 8 (8.7%) patients, skin biopsy in 2 (2.2%), oral mucosal biopsy in 1 (1.1%), lymph node biopsy in 1 (1.1%), renal biopsy in 1 (1.1%) and pleural fluid examination in 1 (1.1%). Bronchoscopic biopsies were diagnostic in 60.9% of sarcoid patients. Twelve (48%) IPF patients had an occupational toxic exposure history. Medical treatment were given to 80 patients. There were good clinical and radiological response in patients with sarcoidosis (96.9%) and cryptogenic organizing pneumonia (COP) (85.7%), however disease was stable in CTD patients and only three of idiopathic pulmonary fibrosis (IPF) patients (15.7%) responded to treatment. In IPF patients, diagnosis was established medially 35.7 months later after the first symptom apeared. Two of the IPF patients had also lung cancer. Treatment related complications occurred in six patients. Fourteen patients died during the follow-up period and eight were IPF. ILD is frequently encountered in general practice of pulmonary physicians and should be considered in differential diagnosis during routine pulmonology clinic. Sarcoidosis and IPF were the most commonly seen diseases. Although ILD is a difficult challenge to diagnose in clinical practice, it may be diagnosed by means of clinical features, radiologic techniques and several biopsy procedures.

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