BACKGROUND:Epithelioid granulomas have been reported in 2-15% of unselected liver biopsies, with numerous underlying aetiologies described. However, all UK series were reported before identification of hepatitis C virus (HCV). AIM:To evaluate the current aetiologies of hepatic granulomas and to assess the prognosis for the "idiopathic" group, in which all investigations for a recognised cause were negative or normal. METHODS:A retrospective review of patient case notes between 1991 and 2001; all patients who had a liver biopsy at Glasgow Royal Infirmary revealing epithelioid granulomas had their case notes and liver biopsies reviewed and a standard proforma completed. RESULTS:Over the study period, 1662 liver biopsies were performed. Hepatic granulomas were found in 63. Of those identified, 47 were female, with a mean age of 42 years (range, 17-81). Underlying aetiologies were as follows: primary biliary cirrhosis (PBC; 23.8%), sarcoidosis (11.1%), idiopathic (11.1%), drug induced (9.5%), HCV (9.5%), PBC/autoimmune hepatitis (AIH) overlap (6.3%), Hodgkin lymphoma (6.3%), AIH (4.8%), tuberculosis (4.8%), resolving biliary obstruction (3.2%), and other single miscellaneous causes (9.5%). Of the seven patients with idiopathic hepatic granulomas, one was lost to follow up, one died of stroke, and the remaining five were well with no liver related morbidity at a mean follow up of 6.2 years. CONCLUSIONS:The aetiology of hepatic granulomas is broad ranging, with HCV an important cause in this population. Despite extensive investigations, a 10-15% of patients still had "idiopathic" hepatic granulomas. However, the prognosis for this last group appears to be excellent.

译文

摘要背景:上皮样肉芽肿在未选择的肝活检样本中占2-15%,并描述了许多潜在病因。但是,在鉴定出丙型肝炎病毒(HCV)之前,所有UK系列文献均已报道。
目的:评估目前肝性肉芽肿的病因并评估“特发性”组的预后,在该组中,所有已知病因的检查均为阴性或正常。
方法:回顾性回顾1991年至2001年间的患者病例记录。在格拉斯哥皇家医院进行肝活检并发现上皮样肉芽肿的所有患者均进行了病例记录和肝活检,并完成了标准备考。
结果:在研究期间,进行了1662例肝活检。在63例中发现了肝肉芽肿。在已发现的肉芽肿中,有47例是女性,平均年龄为42岁(范围17-81)。基本病因如下:原发性胆汁性肝硬化(PBC; 23.8%),结节病(11.1%),特发性(11.1%),药物诱发(9.5%),HCV(9.5%),PBC /自身免疫性肝炎(AIH)重叠( 6.3%),霍奇金淋巴瘤(6.3%),AIH(4.8%),肺结核(4.8%),解决胆道梗阻(3.2%)和其他单一其他原因(9.5%)。在7例特发性肝肉芽肿患者中,1例失访,1例死于中风,其余5例病情良好,平均随访6.2年,无肝病发病率。
结论:肝肉芽肿的病因广泛,其中HCV是该人群的重要原因。尽管进行了广泛的研究,但仍有10-15%的患者患有“特发性”肝肉芽肿。但是,最后一组的预后似乎很好。

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