老年坏死性结节病样肉芽肿病病例报告并文献复习

摘要：Objective To analyze and summarize the clinical characteristics,diagnosis and treatment of necrotizing sarcoid granulomatosis(NSG).Methods A description of an elderly patient with NSG who was diagnosed through biopsy and received treatment at Beijing Hospital and a review of the literature on 73 NSG cases reported in China and elsewhere.Results The patient was a 60-year-old woman presenting with fever,cough and chest pain.Chest CT scan showed multiple miliary nodules without mediastinal adenopathy.A biopsy specimen was taken via thoracoscopy and a diagnosis of NSG was confirmed microscopically.The patient was not given any medication and experienced spontaneous remission.An analysis of a total of 74 NSG cases(including this one and 73 others from literature)shows that 22 of the patients were male and 52 female,aged from 8 to 77 years.Of all the cases,62 involved the lungs alone,while the rest implicated extrapulmonary tissues.The most common complaints were cough(37 cases or 50.0％),fever(28 cases or 37.8％)and chest pain(25 cases or 33.8％).The main imaging findings included multiple pulmonary nodules (38 cases or 51.4％),a solitary nodule (19 cases or 25.7 ％),diffuse infiltrates (29 cases or 39.5 ％) and hilar or mediastinal adenopathies(26 cases or 35.1％).All the cases received definitive diagnosis through biopsy.As for management,41 were treated with glucocorticoids,10 received local surgical resection only,and 20 cases were not given any treatment.Follow-ups ranging from one month to 12 years saw improvement in 68 cases.Conclusions NSG is a rare benign granulomatous disorder.Since it is often misdiagnosed as GPA or Sarcoidosis,its diagnosis needs to be confirmed through surgical pathology.NGS is usually responsive to glucocorticoids and has a generally favorable prognosis.