Clinical significance of granuloma in Crohn's disease
Clinical significance of granuloma in Crohn's disease
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DOI：
10.3748/wjg.v11.i20.3118
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发表时间：
2005-05-28
影响因子：
4.3
通讯作者：
Lonovics, Janos
中科院分区：
文献类型：
--
作者：
Molnar, Tamas;Tiszlavicz, Laszlo;Lonovics, Janos
目的：肉芽肿被认为是克罗恩病(Crohn‘s disease，CD)显微镜诊断的标志，但仅有21-60%的CD患者可检出肉芽肿。本研究的目的是通过多次内窥镜活检评估CD患者中肉芽肿的发生率，并检查有或没有肉芽肿的患者表现出不同的临床过程。方法：56例新诊断的CD患者纳入研究。所有患者均行空肠镜、灌肠和回肠结肠镜检查。对每个检查胃肠道节段的至少两个活检标本进行显微镜检查，以寻找肉芽肿。所有患者均随访临床病程，并记录肠外表现以及任何免疫抑制治疗和手术治疗的细节。结果：44.6%的患者(25例)出现肉芽肿。肉芽肿患者在活检时有较高的活动参数。肉芽肿组可观察到肠外表现，且更常进行手术治疗。在肉芽肿患者中需要免疫抑制治疗的频率明显更高。肉芽肿的形成多见于较年轻的患者，且主要见于严重的活动性穿透性疾病。结论：手术干预和免疫抑制治疗的频率明显较高，提示肉芽肿的形成与CD最初几年的严重病程有关。(C)2005年WJG Press和Elsevier Inc.保留所有权利。
AIM: Granuloma is considered the hallmark of microscopic diagnosis in Crohn's disease (CD), but granulomas can be detected in only 21-60% of CD patients. The aim of this study was to evaluate the frequency of granulomas by multiple endoscopic biopsies in patients with CD and to examine whether group of patients with or without granuloma exhibit a different clinical course.METHODS: Fifty-six patients with newly diagnosed CD were included in the study. Jejunoscopy, enteroclysis and ileo-colonoscopy were performed in all patients. At least two biopsy specimens from each examined gastrointestinal segment were examined microscopically searching granuloma. The clinical course was followed in all patients, and extraintestinal manifestations as well as details of any immunosuppressive therapy and surgical intervention were noted.RESULTS: Granuloma was found in 44.6% of the cases (25 patients). Patients with granuloma had higher activity parameters at the time of the biopsies. Extraintestinal manifestations were observed and surgical interventions were performed more often in the granuloma group. The need of immunosuppressive therapy was significantly more frequent in the patients with granuloma. Granuloma formation is more often seen in younger patients, and mainly in the severe, active penetrating disease.CONCLUSION: The significantly higher frequency of surgical interventions and immunosuppressive therapy suggests that granuloma formation is associated with a more severe disease course during the first years of CD. (C) 2005 The WJG Press and Elsevier Inc. All rights reserved.