Lidar Merav, Langevitz Pnina, Shoenfeld Yehuda
Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel.
Isr Med Assoc J. 2009 Sep;11(9):558-63.
Inflammatory bowel disease, a collective term for ulcerative colitis and Crohn's disease, is a chronic, immune-mediated disease of the gastrointestinal tract that develops in genetically susceptible individuals. The role of infection in the development of inflammatory bowel disease is underscored by various clinical observations, such as the delayed age of onset, suggesting that childhood exposure to pathogens is essential, and the clinical improvement that follows decreasing bacterial intestinal load. Over the years, many a pathogen has been linked to the development and exacerbation of inflammatory bowel disease, notably; Mycobacterium paratuberculosis, Escherichia coli, Listeria monocytogenes and Chlamydia as well as viruses such as measles, mumps, rubella, Epstein-Barr virus and cytomegalovirus. Presently, leading theories of disease pathogenesis suggest loss of immune tolerance to normal commensal bacteria coupled with excessive exposure to bacterial antigenic products. This review describes the most commonly implicated pathogens in the causation of IBD and presents the evidence supporting their pathogenic role as well as data that offset their importance.
炎症性肠病是溃疡性结肠炎和克罗恩病的统称，是一种发生在遗传易感个体中的慢性免疫介导性胃肠道疾病。各种临床观察结果都强调了感染在炎症性肠病发病过程中的作用，比如发病年龄延迟，这表明儿童时期接触病原体至关重要，以及随着肠道细菌负荷降低病情出现临床改善。多年来，许多病原体都与炎症性肠病的发生和加重有关，尤其是副结核分枝杆菌、大肠杆菌、单核细胞增生李斯特菌和衣原体，以及麻疹、腮腺炎、风疹、爱泼斯坦-巴尔病毒和巨细胞病毒等病毒。目前，疾病发病机制的主流理论认为，对正常共生菌的免疫耐受丧失，再加上过度接触细菌抗原产物。这篇综述描述了在炎症性肠病病因中最常涉及的病原体，并提供了支持它们致病作用的证据以及抵消其重要性的数据。
