目的:肉芽肿,主要由巨噬细胞组成,是克罗恩病(CD)的组织学特征。然而,它在CD中的重要性尚未得到充分调查。我们的研究旨在通过比较肉芽肿性和非肉芽肿性CD的临床表现和单核细胞/巨噬细胞亚型来解决这一问题。材料和方法:人口统计,症状,内镜表现,组织病理学特征,比较了有和没有肉芽肿的患者的蒙特利尔分类。流式细胞术用于确定单核细胞的吞噬作用和亚群。ELISA法检测血浆TNF-α水平,IL-6,IL-1β,IL-10、CCL22和TGF-β1。进行免疫组织化学以定量CD68,CD163和iNOS的表达。结果:在入选的222例CD患者中,在90例中检测到肉芽肿。与非肉芽肿性CD患者相比,肉芽肿患者年龄较小,腹泻和肛周并发症的发生率增加,随着较高的内窥镜评分。肉芽肿性CD患者更常观察到肠狭窄和隐窝脓肿。在肉芽肿性CD患者中观察到单核细胞的吞噬缺陷。同时,中间和非经典单核细胞的百分比更高,其中经典单核细胞的比例较低。此外,他们的TGF-β1和IL-10水平较高,TNF-α水平较低,CD163+/CD68+细胞比例增加,iNOS+/CD68+细胞比例降低。结论:肉芽肿性CD患者与非肉芽肿性CD患者表现不同。肉芽肿性CD患者可能需要更积极的治疗。此外,单核细胞/巨噬细胞亚群的异质性和血浆细胞因子的改变可能是两组之间差异的基础.
Aims: Granuloma, mainly composed of macrophages, is a histological feature of Crohn\'s disease (CD). However, its significance in CD has not been investigated adequately. Our study aims to address this issue by comparing the clinical manifestations and monocyte/macrophage subtypes between granulomatous and non-granulomatous CD.Materials and methods: Demographics, symptoms, endoscopic manifestations, histopathological features, and Montreal classification of patients with and without
granulomas were compared. Flow cytometry was used to determine the phagocytosis and subsets of monocytes. ELISA was used to measure the plasma levels of TNF-α, IL-6, IL-1β, IL-10, CCL22, and TGF-β1. Immunohistochemistry was performed to quantify the expression of CD68, CD163 and iNOS.Results: Of the222 CD patients enrolled,
granulomas were detected in 90. Compared with non-granulomatous CD patients, those with
granulomas had younger age, increased rates of diarrhea and perianal complications, along with higher endoscopic score. Intestinal stenosis and crypt abscess were more frequently observed in granulomatous CD patients. A defective phagocytosis of monocytes was observed in granulomatous CD patients. Meanwhile, higher percentages of intermediate and non-classic monocytes, with a lower percentage of classic monocyte were found in them. Besides, they had higher levels of TGF-β1 and IL-10, a lower level of TNF-α, an increased ratio of CD163+/CD68+cells, and a decreased ratio of iNOS+/CD68+ cells.Conclusions: Granulomatous CD patients exhibited different manifestations compared with their non-granulomatous counterparts. More aggressive therapy may be needed in granulomatous CD patients. Furthermore, the heterogeneity of monocyte/macrophage subsets and altered plasma cytokine may underlie the difference between those two groups.