Behr Marcel A, Kapur Vivek
Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Curr Opin Gastroenterol. 2008 Jan;24(1):17-21. doi: 10.1097/MOG.0b013e3282f1dcc4.
Though long hypothesized, the putative link between Mycobacterium avium paratuberculosis and Crohn's disease remains neither confirmed nor refuted. This article reviews published contributions that directly or indirectly address this question.
Epidemiologic studies, looking for M. avium paratuberculosis DNA in Crohn's tissue, show a strong association between the agent and this disease. Supporting data, however, are presently inconclusive on a causal role. Genetic studies provide indirect support for a role of mycobacteria in Crohn's disease, by identifying susceptibility genes that encode proteins implicated in innate immunity to intracellular bacteria. Clinical trial data support at least a short-term benefit for antimycobacterial therapy in Crohn's disease, but the microbial specificity of this response is presently unknown.
There appears to be a strong association between M. avium paratuberculosis and Crohn's disease, but the causality of this association is unknown. Consequently, the therapeutic implications of this association require further study. A number of critical questions about the biology of M. avium paratuberculosis remain unanswered. Data from studies of this organism, and its interaction with the immune system, can help address proposed reasons for or against a role of M. avium paratuberculosis in the etiology of Crohn's disease.
尽管长期以来一直存在假说，但鸟分枝杆菌副结核分枝杆菌与克罗恩病之间的假定联系仍未得到证实或否定。本文回顾了直接或间接探讨这一问题的已发表文献。
在克罗恩病组织中寻找鸟分枝杆菌副结核分枝杆菌DNA的流行病学研究表明，该病原体与这种疾病之间存在密切关联。然而，目前关于因果作用的支持数据尚无定论。基因研究通过鉴定编码参与细胞内细菌固有免疫的蛋白质的易感基因，为分枝杆菌在克罗恩病中的作用提供了间接支持。临床试验数据支持抗分枝杆菌疗法在克罗恩病中至少有短期益处，但目前尚不清楚这种反应的微生物特异性。
鸟分枝杆菌副结核分枝杆菌与克罗恩病之间似乎存在密切关联，但这种关联的因果关系尚不清楚。因此，这种关联的治疗意义需要进一步研究。关于鸟分枝杆菌副结核分枝杆菌生物学的一些关键问题仍未得到解答。对该病原体及其与免疫系统相互作用的研究数据，有助于探讨支持或反对鸟分枝杆菌副结核分枝杆菌在克罗恩病病因学中作用的提出的理由。
