BACKGROUND & AIMS: OBJECTIVE:The purpose of this study was to determine the expression of receptor activator of NFkappaB ligand (RANKL) and osteoprotegerin (OPG) associated with bone destruction in periapical cysts and granulomas. STUDY DESIGN:Forty human dental chronic periapical lesions were collected after periapical surgery. The lesions collected were fixed in 10% buffered formalin and histologically processed. At least 2 sections of each specimen were stained with hematoxylin and eosin for microscopic diagnosis. After that, 10 human periapical granulomas and 10 cysts were selected for immunohistochemical analysis for RANKL, OPG, and CD68+. RESULTS:Polymorphonuclear neutrophils, macrophages, endothelial cells, and lymphocytes were stained for RANKL and OPG in both lesions. Epithelial cells were also stained for RANKL and OPG in periapical cysts. Quantitative analysis was conducted and the results were expressed as a ratio of the number of immunostained cells over the total number of cells in the field (n = 100). The ratio of RANKL+/total cells was higher than OPG+/total cells in periapical granulomas (0.553 +/- 0.153 and 0.483 +/- 0.189, respectively; P < .0012; paired t test) and in cysts (0.519 +/- 0.09 and 0.339 +/- 0.117, respectively; P < .0001; paired t test). The ratios of OPG+/total cells (P < .0001; paired t test) and RANKL+/total cells (P < .0322; paired t test) were greater in granulomas than in cysts. However, the ratio RANKL+/OPG+ in granulomas (1.336 +/- 0.723) and cysts (1.404 +/- 0.385) was not significantly different. The ratio of CD68+/total cells was significantly higher in granulomas (0.381 +/- 0.040) than in cysts (0.307 +/- 0.068) (P < .0001; unpaired t test with Welch correction). CONCLUSION:Taking into account the limitations of the experimental approach employed, our findings indicate the presence of RANKL and OPG in cysts and granulomas, strongly suggesting the involvement of these gene products in the development of periapical lesions.

背景与目标： 目的：本研究旨在确定与根尖周囊肿和肉芽肿中的骨破坏有关的NFkappaB配体（RANKL）和骨保护素（OPG）受体激活剂的表达。
研究设计：根尖周手术后收集了40例人类牙齿慢性根尖周病变。将收集的病灶固定在10％的福尔马林缓冲液中，并进行组织学处理。每个标本至少2个切片用苏木精和曙红染色以进行显微镜诊断。之后，选择10个人根尖肉芽肿和10个囊肿进行RANKL，OPG和CD68的免疫组织化学分析。
结果：在两个病变中，多形核中性粒细胞，巨噬细胞，内皮细胞和淋巴细胞均进行了RANKL和OPG染色。还对上皮周囊肿中的上皮细胞进行了RANKL和OPG染色。进行定量分析，结果表示为免疫染色细胞数与现场细胞总数之比（n = 100）。根尖肉芽肿中RANKL /总细胞的比率高于OPG /总细胞的比率（分别为0.553 /-0.153和0.483 /-0.189; P <.0012;成对t检验）和囊肿中（0.519 /-0.09和0.339 / -分别为0.117； P <.0001；成对t检验）。肉芽肿中OPG /总细胞（P <.0001；成对t检验）与RANKL /总细胞（P <.0322；成对t检验）的比率大于囊肿。然而，肉芽肿（1.336 /-0.723）和囊肿（1.404 /-0.385）中的RANKL / OPG比率没有显着差异。肉芽肿中CD68 /总细胞的比率（0.381 /-0.040）显着高于囊肿（0.307 /-0.068）（P <.0001；采用Welch校正的未配对t检验）。
结论：考虑到所用实验方法的局限性，我们的发现表明囊肿和肉芽肿中存在RANKL和OPG，强烈暗示这些基因产物参与了根尖周病变的发展。

BACKGROUND & AIMS: :Clearance of intracellular infections caused by Salmonella Typhimurium (STm) requires IFN-γ and the Th1-associated transcription factor T-bet. Nevertheless, whereas IFN-γ-/- mice succumb rapidly to STm infections, T-bet-/- mice do not. In this study, we assess the anatomy of immune responses and the relationship with bacterial localization in the spleens and livers of STm-infected IFN-γ-/- and T-bet-/- mice. In IFN-γ-/- mice, there is deficient granuloma formation and inducible NO synthase (iNOS) induction, increased dissemination of bacteria throughout the organs, and rapid death. The provision of a source of IFN-γ reverses this, coincident with subsequent granuloma formation and substantially extends survival when compared with mice deficient in all sources of IFN-γ. T-bet-/- mice induce significant levels of IFN-γ- after challenge. Moreover, T-bet-/- mice have augmented IL-17 and neutrophil numbers, and neutralizing IL-17 reduces the neutrophilia but does not affect numbers of bacteria detected. Surprisingly, T-bet-/- mice exhibit surprisingly wild-type-like immune cell organization postinfection, including extensive iNOS+ granuloma formation. In wild-type mice, most bacteria are within iNOS+ granulomas, but in T-bet-/- mice, most bacteria are outside these sites. Therefore, Th1 cells act to restrict bacteria within IFN-γ-dependent iNOS+ granulomas and prevent dissemination.

背景与目标： ：清除由鼠伤寒沙门氏菌（STm）引起的细胞内感染需要IFN-γ和Th1相关转录因子T-bet。但是，尽管IFN-γ-/-小鼠迅速死于STm感染，但T-bet-/-小鼠却没有。在这项研究中，我们评估了免疫应答的解剖结构以及与细菌感染STm感染的IFN-γ-/-和T-bet-/-小鼠的脾脏和肝脏的关系。在IFN-γ-/-小鼠中，肉芽肿形成不足和可诱导的NO合酶（iNOS）诱导，细菌在整个器官中的传播增加，并迅速死亡。与缺乏所有IFN-γ来源的小鼠相比，提供IFN-γ的来源可以逆转这种情况，与随后的肉芽肿形成同时发生，并且可以大大延长生存期。攻击后，T-bet-/-小鼠诱导显着水平的IFN-γ-。此外，T-bet-/-小鼠的IL-17和嗜中性粒细胞数目增加，而中和IL-17会减少嗜中性粒细胞，但不会影响所检测细菌的数目。令人惊讶地，T-bet-/-小鼠在感染后表现出令人惊讶的野生型样免疫细胞组织，包括广泛的iNOS肉芽肿形成。在野生型小鼠中，大多数细菌都位于iNOS肉芽肿内，但在T-bet-/-小鼠中，大多数细菌都位于这些部位之外。因此，Th1细胞的作用是将细菌限制在IFN-γ依赖性iNOS肉芽肿中，并阻止其传播。

BACKGROUND & AIMS: :Several unusual variants of lichen nitidus are described in the literature. Spinous follicular lichen nitidus with perifollicular granulomas is one such variant characterized by generalized follicular as well as nonfollicular keratotic papules, which show perifollicular granulomas on histopathology as well as a lichenoid granulomatous tissue reaction typical of lichen nitidus. Owing to its atypical clinical and histopathologic manifestations, it raises several clinical possibilities and can be a diagnostic challenge. We report this rare variant of lichen nitidus in a 19-year-old female, and discuss its clinical and histopathological differential diagnosis.

背景与目标： ：地衣针的几种不寻常的变种在文献中有描述。伴有滤泡性肉芽肿的棘状卵泡性地衣针状变体是一种这样的变体，其特征在于全身性滤泡性和非滤泡性角化丘疹，其表现出组织病理学上的滤泡性肉芽肿以及典型的地衣性肉芽肿性肉芽肿组织反应。由于其非典型的临床和组织病理学表现，它提出了几种临床可能性，并且可能是诊断上的挑战。我们在19岁的女性中报告了这种罕见的地衣针状变体，并讨论了其临床和组织病理学鉴别诊断。

BACKGROUND & AIMS: INTRODUCTION:The presence of granulomas on tissue biopsie has been reported in a wide range of disorders. The clinical presentation and the diagnostic work-up of granulomatosis can be difficult as it is illustrated in the following report. CASE REPORT:A 59-year-old patient was referred in 2002 for a granulomatous prostatitis. Physical examination was normal. Except for the increase of prostate-specific antigen (which motivated a biopsy), the laboratory results were normal. Thoracic CT-scan disclosed mediastinal lymph nodes. A minor salivary gland biopsy was consistent with the diagnosis of sarcoidosis. In 2004, the patient presented an epidermal necrolysis, and in 2005 the deterioration of general status raised suspicion of a lymphoproliferative disorder. Liver and bone marrow biopsies revealed a granulomatous process. Despite steroid therapy, the patient died. Autopsy discloses a anaplasic T cell lymphoma. CONCLUSION:This report illustrates the relationship between sarcoidosis and lymphoma as a mode of presentation, a complication, or an accidental but misleading association? The association between anaplastic lymphoma and sarcoidosis is exceptional.

背景与目标： 简介：在组织活检中肉芽肿的存在已报道为多种疾病。肉芽肿病的临床表现和诊断检查可能很困难，如以下报告所示。
病例报告：2002年，一名59岁的患者因肉芽肿性前列腺炎被转诊。体检正常。除了前列腺特异性抗原的增加（促使活组织检查）外，实验室检查结果是正常的。胸部CT扫描揭示了纵隔淋巴结。唾液腺轻度活检与结节病的诊断一致。在2004年，患者出现了表皮坏死，在2005年，一般状况的恶化引起了对淋巴增生性疾病的怀疑。肝和骨髓活检显示肉芽肿过程。尽管进行了类固醇治疗，该患者仍然死亡。尸检揭示了无瓣膜T细胞淋巴瘤。
结论：本报告说明结节病和淋巴瘤之间的关系是一种表现方式，并发症或偶然但误导的关联？间变性性淋巴瘤和结节病之间的关联是例外。

BACKGROUND & AIMS: 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.

背景与目标： 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。

BACKGROUND & AIMS: :FTY720 is a treatment for relapsing remitting multiple sclerosis (MS). It is an analog of sphingosine-1-phosphate (S1P) and targets S1P receptors 1, 3, 4, and 5. Recent reports indicate an association between long-term exposure to FTY720 and cases of cryptococcal infection. Here, we studied the effect of FTY720 and its derivative, BAF312, which only target S1P receptors 1 and 5, in a mouse model of cryptococcal infection. We found that treatment with FTY720, but not with BAF312, led to decreased survival and increased organ burden in mouse cryptococcal granulomas. Both FTY720 and BAF312 caused a profound CD4+ and CD8+ T cell depletion in blood and lungs but only treatment with FTY720 led to cryptococcal reactivation. Treatment with FTY720, but not with BAF312, was associated with disorganization of macrophages and with M2 polarization at the granuloma site. In a cell system, FTY720 decreased phagocytosis and production of reactive oxygen species by macrophages, a phenotype recapitulated in the S1pr3-/- knockout macrophages. Our results suggest that FTY720 reactivates cryptococcosis from the granuloma through a S1P receptor 3-mediated mechanism and support the rationale for development of more-specific receptor modulators for therapeutic use of MS.

背景与目标： ：FTY720是一种复发缓解型多发性硬化症（MS）的治疗方法。它是1-磷酸鞘氨醇（S1P）的类似物，靶向S1P受体1、3、4和5。最近的报道表明，长期暴露于FTY720与隐球菌感染病例之间存在关联。在这里，我们研究了仅针对S1P受体1和5的FTY720及其衍生物BAF312在隐球菌感染的小鼠模型中的作用。我们发现，用FTY720而不是BAF312进行治疗会导致小鼠隐球菌肉芽肿存活率降低和器官负担增加。 FTY720和BAF312均可在血液和肺部引起严重的CD4和CD8 T细胞耗竭，但仅FTY720治疗可导致隐球菌再激活。用FTY720而不是BAF312进行的治疗与巨噬细胞的紊乱和肉芽肿部位的M2极化有关。在细胞系统中，FTY720减少了巨噬细胞的吞噬作用和活性氧的产生，巨噬细胞是在S1pr3-/-敲除巨噬细胞中概括的表型。我们的研究结果表明FTY720通过S1P受体3介导的机制从肉芽肿中重新激活隐球菌病，并支持开发更特异性的受体调节剂以用于MS的治疗。

BACKGROUND & AIMS: :We examined the presence of the receptor for advanced glycation end products (RAGE) in periapical granulomas and analyzed the interaction between RAGE and inducible nitric oxide synthase (iNOS) to elucidate inflammatory reaction mechanisms. Periapical lesions were surgically removed from 37 patients with chronic periapical periodontitis and halved. Paraffin sections were prepared from half of each lesion and stained with hematoxylin and eosin, whereas cryostat sections were prepared from the other half. Based on the histological evaluation, 33 of the lesions were diagnosed as periapical granulomas. These were examined by immunohistochemistry using serial cryostat sections probed with anti-human iNOS or RAGE antibodies. Macrophages, lymphocytes, and endothelial cells expressed RAGE and these cell types, in addition to plasma cells, exhibited anti-iNOS immunoreactivity. Serial cryostat sections demonstrated the infiltration of RAGE-expressing cells around iNOS-producing cells, suggesting that these molecules may be important in the tissue injury associated with periapical periodontitis.

背景与目标： ：我们检查了根尖周肉芽肿中晚期糖基化终末产物受体（RAGE）的存在，并分析了RAGE与诱导型一氧化氮合酶（iNOS）之间的相互作用以阐明炎症反应机制。通过手术将37例慢性根尖周周炎患者的根尖病变切除并减半。从每个病变的一半制备石蜡切片，并用苏木精和曙红染色，而从另一半制备低温恒温器切片。根据组织学评估，其中33个病变被诊断为根尖肉芽肿。通过使用连续低温恒温器切片的抗人iNOS或RAGE抗体进行免疫组织化学检查，对它们进行了检查。巨噬细胞，淋巴细胞和内皮细胞表达RAGE，除浆细胞外，这些细胞类型还表现出抗iNOS免疫反应性。连续低温恒温器切片显示了表达iAGES的细胞周围表达RAGE的细胞的浸润，表明这些分子可能在与根尖周炎相关的组织损伤中很重要。

BACKGROUND & AIMS: :Due to the high lipid content of the caseous material in granulomas of the lung, these lesions may radiographically mimic truly cavitated pulmonary neoplasms or granulomas. Four cases of pseudocavitation within granulomas of the lung are presented along with their clinical, radiographic, and pathologic features. In all four cases diagnosis was made only after surgery.

背景与目标： ：由于肺肉芽肿中干酪样物质的高脂质含量，这些病变可能在影像学上模仿真正的空化肺肿瘤或肉芽肿。介绍了肺肉芽肿内的四例假空化及其临床，影像学和病理学特征。在所有四例中，仅在手术后进行诊断。

BACKGROUND & AIMS: :Granuloma formation is a form of delayed-type hypersensitivity requiring CD4(+) T cells. Granulomas control the growth and dissemination of pathogens, preventing host inflammation from harming surrounding tissues. Using a murine model of Mycobacterium bovis strain bacillus Calmette-Guérin (BCG) infection we studied the extent of T cell heterogeneity present in liver granulomas. We demonstrate that the TCR repertoire of granuloma-infiltrating T cells is very diverse even at the single-granuloma level, suggesting that before granuloma closure, a large number of different T cells are recruited to the lesion. At the same time, the TCR repertoire is selected, because AND TCR transgenic T cells (Valpha11/Vbeta3 anti-pigeon cytochrome c) are preferentially excluded from granulomas of BCG-infected AND mice, and cells expressing secondary endemic Vbeta-chains are enriched among AND cells homing to granulomas. Next, we addressed whether TCR heterogeneity is required for effective granuloma formation. We infected 5CC7/recombinase-activating gene 2(-/-) mice with recombinant BCG that express pigeon cytochrome c peptide in a mycobacterial 19-kDa bacterial surface lipoprotein. A CD4(+) T cell with a single specificity in the absence of CD8(+) T cells is sufficient to form granulomas and adequately control bacteria. Our study shows that expanded monoclonal T cell populations can be protective in mycobacterial infection.

背景与目标： 肉芽肿的形成是需要CD4（）T细胞的迟发型超敏反应的一种形式。肉芽肿控制病原体的生长和传播，防止宿主发炎损害周围组织。我们使用牛分枝杆菌菌株卡介苗（BCG）感染的小鼠模型研究了肝肉芽肿中T细胞异质性的程度。我们证明，即使在单个肉芽肿水平上，肉芽肿浸润性T细胞的TCR谱也非常多样化，这表明在肉芽肿闭合之前，大量不同的T细胞被募集到病变处。同时，选择TCR曲目，是因为从BCG感染的AND小鼠肉芽肿中优先排除了AND TCR转基因T细胞（Valpha11 / Vbeta3抗鸽子细胞色素c），并且表达次级地方性Vbeta链的细胞富集了AND细胞归巢为肉芽肿。接下来，我们探讨了有效形成肉芽肿是否需要TCR异质性。我们用重组BCG感染5CC7 /重组酶激活基因2（-/-）小鼠，该BCG在分枝杆菌19-kDa细菌表面脂蛋白中表达鸽子细胞色素c肽。在没有CD8（T）细胞的情况下，具有单一特异性的CD4（T）细胞足以形成肉芽肿并充分控制细菌。我们的研究表明，扩大的单克隆T细胞群体可以在分枝杆菌感染中起到保护作用。

BACKGROUND & AIMS: :Four cases of intradural extramedullary tuberculous spinal granulomas without bony involvement are presented. Both, the rarity of the disease, as well as the successful microsurgical resection with good recovery prompted this report. The pathogenesis with the controversies therein, is discussed and pertinent literature is reviewed.

背景与目标： ：介绍了4例无骨累及的硬膜内髓外结核性肉芽肿病例。该疾病的稀有性以及成功进行了良好康复的显微外科切除术均促使了这一报道。讨论了其中存在争议的发病机理，并复习了相关文献。

BACKGROUND & AIMS: :Tuberculosis is a common infection in Taiwan, and it is probably a cause of reactive hemophagocytic syndrome. We report the case of a 63-year-old man with initial presentation of fever and progressive jaundice. Hemophagocytic syndrome was documented by the findings of peripheral blood smear and bone marrow biopsy. Although chemotherapy and antituberculous therapy were administered early, he passed away. Sputum and bone marrow cultures confirmed the presence of Mycobacterium tuberculosis 3 weeks later. Bone marrow biopsy revealed noncaseating granuloma. Patients with hemophagocytic syndrome should be rigorously screened for tuberculosis and antituberculous therapy should be initiated early to improve prognosis.

背景与目标： ：结核病是台湾常见的感染，可能是反应性噬血细胞综合征的病因。我们报告了最初发烧和进行性黄疸的63岁男性病例。通过外周血涂片检查和骨髓活检发现有吞噬细胞综合征。尽管尽早进行了化学疗法和抗结核治疗，但他去世了。 3周后，痰液和骨髓培养物证实存在结核分枝杆菌。骨髓活检显示无干酪性肉芽肿。应严格筛查有吞噬细胞综合征的患者是否患有结核病，并应尽早开始抗结核治疗以改善预后。

BACKGROUND & AIMS: :Tuberculosis (TB), caused by Mycobacterium tuberculosis, continues to be a major global health problem. Lung granulomas are organized structures of host immune cells that function to contain the bacteria. Cytokine expression is a critical component of the protective immune response, but inappropriate cytokine expression can exacerbate TB. Although the importance of proinflammatory cytokines in controlling M. tuberculosis infection has been established, the effects of anti-inflammatory cytokines, such as IL-10, in TB are less well understood. To investigate the role of IL-10, we used an Ab to neutralize IL-10 in cynomolgus macaques during M. tuberculosis infection. Anti-IL-10-treated nonhuman primates had similar overall disease outcomes compared with untreated control nonhuman primates, but there were immunological changes in granulomas and lymph nodes from anti-IL-10-treated animals. There was less thoracic inflammation and increased cytokine production in lung granulomas and lymph nodes from IL-10-neutralized animals at 3-4 wk postinfection compared with control animals. At 8 wk postinfection, lung granulomas from IL-10-neutralized animals had reduced cytokine production but increased fibrosis relative to control animals. Although these immunological changes did not affect the overall disease burden during the first 8 wk of infection, we paired computational modeling to explore late infection dynamics. Our findings support that early changes occurring in the absence of IL-10 may lead to better bacterial control later during infection. These unique datasets provide insight into the contribution of IL-10 to the immunological balance necessary for granulomas to control bacterial burden and disease pathology in M. tuberculosis infection.

背景与目标： 结核分枝杆菌引起的结核病（TB）仍然是全球主要的健康问题。肺肉芽肿是宿主免疫细胞的组织结构，其功能是遏制细菌。细胞因子的表达是保护性免疫反应的关键组成部分，但是不适当的细胞因子表达会加剧结核病。尽管已经确定了促炎细胞因子在控制结核分枝杆菌感染中的重要性，但人们对抗炎细胞因子（如IL-10）在结核病中的作用还知之甚少。为了研究IL-10的作用，我们在结核分枝杆菌感染期间使用了Ab中和猕猴猕猴中的IL-10。与未经治疗的对照非人类灵长类动物相比，抗IL-10-处理的非人类灵长类动物具有相似的总体疾病结局，但抗IL-10处理的动物的肉芽肿和淋巴结免疫学改变。与对照动物相比，在感染后3-4周，IL-10中和动物的肺肉芽肿和淋巴结中的胸腔炎症减少，细胞因子产生增加。感染后第8周，来自IL-10中和动物的肺肉芽肿与对照动物相比，细胞因子产生减少，但纤维化增加。尽管这些免疫学变化在感染的前8周内并未影响总体疾病负担，但我们将计算模型配对以探讨晚期感染动态。我们的发现支持在缺乏IL-10的情况下发生早期变化可能会在感染后期导致更好的细菌控制。这些独特的数据集可洞察IL-10对肉芽肿控制结核分枝杆菌感染中细菌负担和疾病病理所必需的免疫平衡的贡献。

BACKGROUND & AIMS: BACKGROUND:The determinants for recurrence of Crohn's disease remain controversial. Eight factors that might predict recurrence were studied in 130 patients operated on for Crohn's disease over a 24-year period.

METHODS:Separate survival curves were estimated for each variable. A multivariate analysis was then carried out in which several selected explanatory variables were included simultaneously in a proportional hazards regression model.

RESULTS:Operation for recurrent disease was necessary in 36 patients. Univariate analysis revealed a highly significant relationship between the presence of granulomas and subsequent recurrence (P = 0.003). There was a trend towards increased recurrence in patients with ileocolonic disease and segmental colectomy (P = 0.11 and P = 0.1 respectively). Age, sex, length of history, indication for operation and affected lines of transection were not associated with recurrence. After multivariate analysis, the association of granulomas with recurrence remained significant (P = 0.03). This association persisted when death was regarded as a treatment failure (P = 0.02).

CONCLUSION:The presence of granulomas in patients with Crohn's disease is significantly associated with recurrence.

背景与目标： 背景：克罗恩氏病复发的决定因素仍有争议。在24年的时间里，对130位接受克罗恩病手术的患者进行了八项可能预测复发的因素的研究。

方法：估计每个变量的独立生存曲线。然后进行了多变量分析，其中在比例风险回归模型中同时包含了几个选定的解释变量。

结果：36例患者必须进行复发性疾病手术。单因素分析显示肉芽肿的存在与随后的复发之间存在高度显着的相关性（P = 0.003）。回肠结肠疾病和节段性结肠切除术的患者有增加复发的趋势（分别为P = 0.11和P = 0.1）。年龄，性别，病史长度，手术指征和横断线均与复发无关。经过多变量分析，肉芽肿与复发的关联仍然很显着（P = 0.03）。当死亡被视为治疗失败时，这种关联仍然存在（P = 0.02）。

结论：克罗恩病患者肉芽肿的存在与复发密切相关。