Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
2005-2010 Yılları Arasında Difüz Parankimal Akciğer Hastalığı Tanısı Konan Hastaların Değerlendirilmesi
The Evaluation of Patients Diagnosed as Diffuse Parenchymal Lung Diseases Between Years 2005-2010
Dilek KARADOĞANa, Göksel ALTINIŞIKb
aGöğüs Hastalıkları AD, Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Rize, TÜRKİYE
bGöğüs Hastalıkları AD, Pamukkale Üniversitesi Tıp Fakültesi, Denizli, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2019;4(1):34-42
doi: 10.5336/healthsci.2018-62248
Article Language: TR
Full Text
ÖZET
 Amaç: Difüz parankimal akciğer hastalıkları (DPAH), tanı ve tedavisi çeşitlilik gösteren akciğer parankim tutulumu ile karakterize olan bir grup hastalığı içermektedir. Bu çalışma ile polikliniğimizde bu tanıyı alan hastaların özellikleriyle beraber tanısal ve tedavisel yaklaşımlarımızı sunulması amaçlanmıştır. Gereç ve Yöntemler: Ocak 2005-Aralık 2010 tarihleri arasında polikliniğimize başvuran ve DPAH tanısı alan toplam 145 hasta çalışmaya dâhil edildi. Hastalar tanılarına göre gruplandırılarak değerlendirildi. İzlemde kalan hastaların klinik özellikleri, tedavileri, tedavi yanıtları değerlendirildi. Bulgular: Hastalarımızın %53,7'si kadın, %46,2'si erkek olup, yaş ortalamaları 55,2±13,5 (21-83) yıl idi. Nefes darlığı (%78,6) en sık başvuru yakınmaları idi. Fizik muayenede en sık velkro ral (%68,9) ve çomak parmak (%22,7) bulguları saptandı. Tanılardan idiyopatik interstisyel pnömoniler (%42), sarkoidoz (%24,1) ve kollajen doku hastalığına bağlı akciğer tutulumu (%19,3) çoğunluğu oluşturmaktaydı. Hastaların %60'ında klinik ve radyolojik bulgularla, %40'ında invaziv yöntemler kullanılarak tanı elde edilmiştir. İnvaziv tanı yöntemleriyle tanı elde etme sıklığı sırasıyla; mediastinal veya skalen lenf bezi biyopsisi (%16,5), cerrahi akciğer biyopsisi (%11) ve bronkoskopik tanı yöntemleriyle (%8,2) idi. Tedavi sonuçlarında, iyi seyir gösteren 62 hastanın çoğunluğunu sarkoidoz (%37) ve kollajen doku hastalığı olanlar (%30,6) oluşturuyordu. Sonuç: Bu çalışmadaki DPAH tanılı hastaların dağılımı incelendiğinde, literatürle uyumlu olarak sarkoidoz ve idiyopatik pulmoner fibrozun en sık görüldüğü saptandı. Güncel, daha az invaziv tanı yöntemleri ile ayırıcı tanı uygulanması tedavi başarısını artırma açısından değerlidir.

Anahtar Kelimeler: İdiyopatik intestisyel pnömoniler; sarkoidoz; idiyopatik pulmoner fibröz; kriptojenik organize pnömoni
ABSTRACT
 Objective: Diffuse parenchymal lung diseases (DPLD) includes a group diseases characterised with lung parenchymal damage and have various diagnostic and treatment modalities. By this study, we aimed to present characteristics of our DPAH patients and our diagnostic and therapeutic approaches. Material and Methods: Among patients that have applied to our outpatient clinic between January 2005-December 2010, 145 patients with DPLD diagnosis were evaluated retrospectively. The data regarding their clinical, radiological and laboratory findings were obtained both from their manually filled records and electronic hospital records. Patients were categorized and evaluated according to their final diagnosis. Results: Out of 145 patients 53.7% of them was female and 46.2% of them was male. Mean age of the study population was 55.2±13.5 years (range: 21-83). Dyspnea with 78.6% was the most common symptom at admission and fine crackles (68.9%) and clubbing (22.7%) were the most common physical examination findings. Idiopathic interstitial pneumonia (42%), sarcoidosis (24.1%), lung involvement of connective tissue disease (ILD-CTD) (19.3%) were constituted the most common diagnoses. In the aspect of the mostly used diagnostic procedures, 60% of the patients were diagnosed by using clinical and radiological findings and 40% of the patients were underwent an invassive prochedure. Mediastinal or scalene lymph node biopsy (16.5%), surgical lung biopsy (11%) and bronchoscopic prochedures (8.2%) were the commonly used invassive methods. By considering the treatment results, good clinical and radiological response was found in patients with sarcoidosis (37%) and ILD-CTD (30.6%). Conclusion: In our study, sarcoidosis and idiopathic pulmonary fibrosis were the most commonly seen diseases. Although DPLD is a difficult challenge to diagnose in clinical practice, novel diagnostic approaches are fundamental for appropriate diferantial diagnosis and treatment success.

Keywords: Idiopathic interstitial pneumonia; sarcoidosis; idiopathic pulmonary fibrosis; cryptogenic organizing pneumonia
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