The Current Status In Clinical Diagnosis And Treatment Of Granulomatous Lung Disease

Background:Granulomatous Lung Disease(GLD) or lung granulomatosis, is a set of lung diseases which have different causes but have a common pathological feature of the formation of granuloma. GLD is relatively common in clinical practice, ranging from common varieties including tuberculosis and sarcoidosis to uncommon ones including Wegener’s granulomatosis and Churg-Stauss Syndrome as well as rare types. They have not only different causes but also different characteristics on the epidemiology, clinical manifestations, imaging findings, laboratory examination and so on. In addition, there is a significant difference in treatment.Objective: Our aim is to study up the clinical characteristics of GLD, summarize the methods of diagnosis and treatment of GLD in order to improve clinical doctors’ understanding and raise diagnosis and treatment level.Methods:Hundreds of related literatures have been retrieved through Pub Med and CNKI et.al. By reviewing these studies, we summarize the research status about the etiology and pathogenesis of GLD and various aspects of pulmonary tuberculosis, sarcoidosis, Wegener’s granulomatosis, Churg-Stauss Syndrome such as epidemiology, clinical manifestation, diagnosis, treatment and so on, for getting certain guiding significance to the clinical work. In addition, the main points of differential diagnosis of tuberculosis and sarcoidosis as well as Wegener’s granulomatosis and Churg-Stauss Syndrome are summarized.Conclusion:According to different causes, GLD is divided into infectious and non-infectious ones with the latter including many diseases of unknown etiology. It has been reported in many domestic and foreign literature that a variety of factors such as heredity, environment, immunity, infection may play a role in its pathogenesis, but there are still lack of consensus.The formation of granuloma is a common pathological feature of GLD, but various kinds have their respective characteristics which often become the key to the diagnosis and differential diagnosis.These diseases have certain characteristics in epidemiology,clinical manifestation, imaging manifestation, laboratory examination and all that, which can provide clues for clinical diagnosis. But it is lack of effective diagnostic method whose both specificity and sensitivity are high.Main treatment of infectious GLD consists of anti-infective therapy and symptomatic treatment. For non-infectious GLD such as sarcoidosis, Wegener’s granulomatosis, Churg-Stauss Syndrome, glucocorticoids and immunosuppressor remains the drug of first choice, which means limited kinds of methods. What is more, long-term application gives rise to many adverse effects and inappropriate dosage and reduction speed may cause the condition to repeat.Prognosis of GLD has close relationship with early effective treatment. Furthermore, it is also related to such factors as the visceras involved and presence of complications.