Vilaseca J, Guardia J, Cuxart A, Clotet B, Martínez-Vázquez J M, Bernardó L, Masana L, García-Vanrell G, Bacardí R
Med Clin (Barc). 1979 Apr 10;72(7):272-5.
An etiologic study was made of 107 cases of granulomatous hepatitis which were observed in a Department of Internal Medicine between January, 1971 and December, 1977 (excluding the hepatobiliary diseases). The most common etiology was tuberculosis (30 cases, 28 percent) followed by sarcoidosis (19 cases, 17.7 percent), Mediterranean exanthematous fever (13 cases, 12.1 percent), brucellosis (8 cases, 7.4 percent) typhoid fever (7 cases, 6.5 percent) and the idiopathic forms (8 cases, 7.4 percent). A lower rate of incidence was among Hodgkin's disease, toxoplasmosis, adenocarcinomas, leprosy, and those of unknown etiology, classified in this way because the study and follow-up of the patients could not be completed. There were, moreover, individual cases caused by mononucleosis, BCG reaction, hypogammaglobulinemia, celiac disease, and temporal arteritis. From a clinical point of view 50 percent of the patients had hepatomegaly and moderate disturbance of the liver enzymes. The most important enzymatic increases were detected in the cases caused by brucellosis; in the cases which were secondary to sarcoidosis the liver enzymes were normal. A comparison is established between the etiologic incidence of the present series and of others published in the literature. The causes and diagnostic problems of this type of lesion are discussed.
对1971年1月至1977年12月期间在某内科观察到的107例肉芽肿性肝炎病例(不包括肝胆疾病)进行了病因学研究。最常见的病因是结核病(30例,28%),其次是结节病(19例,17.7%)、地中海疹热(13例,12.1%)、布鲁氏菌病(8例,7.4%)、伤寒(7例,6.5%)和特发性类型(8例,7.4%)。霍奇金病、弓形虫病、腺癌、麻风病以及病因不明者的发病率较低,之所以这样分类是因为对这些患者的研究和随访未能完成。此外,还有由单核细胞增多症、卡介苗反应、低丙种球蛋白血症、乳糜泻和颞动脉炎引起的个别病例。从临床角度看,50%的患者有肝肿大和肝酶轻度异常。布鲁氏菌病所致病例中检测到最重要的酶升高;结节病继发的病例中肝酶正常。将本系列病例的病因发生率与文献中发表的其他系列进行了比较。讨论了这类病变的病因及诊断问题。