HEPATIC GRANULOMATOSIS AND SARCOIDOSIS - FURTHER OBSERVATIONS
HEPATIC GRANULOMATOSIS AND SARCOIDOSIS - FURTHER OBSERVATIONS
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DOI：
10.1007/bf01318522
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发表时间：
1984-01-01
影响因子：
3.1
通讯作者：
ROSE, LJ
中科院分区：
文献类型：
--
作者：
ISRAEL, HL;MARGOLIS, ML;ROSE, LJ
在胸部X线片正常的病人中发现的肝肉芽肿的病因是有争议的。在近年来研究的18例此类患者中，15例通过采用各种活检方法证实肝外组织中的肉芽肿性炎症而确定结节病为病因。所有10例患者的血清血管紧张素水平均升高，6例中有4例Ga扫描有帮助。持续发热是最常见的症状，但3例患者有严重的右上腹疼痛，以前没有描述的肝结节病的表现。在14例接受治疗的患者中观察到皮质类固醇的改善，但在3例病例中不完全反应导致使用细胞毒性药物。结节病表现为胸部X线片正常的情况比我们所认识的要多，这似乎是不明原因的持续性肝肉芽肿病的一个常见原因。由于治疗是漫长而令人沮丧的，因此应确定明确的诊断。预后良好，但大多数情况下需要多年治疗。
The etiology of hepatic granulomatosis discovered in patients with normal chest roentgenograms is controversial. Among 18 such patients studied in recent years, sarcoidosis was identified as the cause in 15 by demonstration of granulomatous inflammation in extrahepatic tissues, employing a variety of biopsy methods. Serum angiotensin levels were raised in all 10 patients tested and Ga scans were helpful in 4 of 6 cases. Prolonged fever was the most common symptom, but 3 patients had severe right upper quadrant pain, a manifestation of hepatic sarcoidosis not previously described. Improvement on corticosteroids was observed in the 14 treated patients, but incomplete response led to use of cytotoxic drugs in 3 cases. Sarcoidosis presents with normal chest roentgenograms more often than is appreciated and appears to be a common cause of unexplained persistent hepatic granulomatosis. A firm diagnosis should be established since treatment is long and frustrating. The prognosis is good but treatment for years is required in most cases.