探讨炎症性肠病患者的肠病毒组：有罪还是无罪？

Looking into Enteric Virome in Patients with IBD: Defining Guilty or Innocence?

机构信息

*Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, University of Porto, Porto, Portugal; †Clinical Pathology Department, Centro Hospitalar São João, Porto, Portugal; ‡Health Information and Decision Sciences Department, Faculty of Medicine of Porto and CINTESIS- Center for Health Tecnology and Services Research, Porto, Portugal; and §Pathology Department, Faculty of Medicine, Centro Hospitalar São João, University of Porto, Porto, Portugal.

出版信息

Inflamm Bowel Dis. 2017 Aug;23(8):1278-1284. doi: 10.1097/MIB.0000000000001167.

DOI:10.1097/MIB.0000000000001167

PMID:28617757

Abstract

BACKGROUND

Although there is some evidence suggesting that certain viruses may be involved in the onset of inflammatory bowel disease (IBD), data regarding viral prevalence and viral load in blood and mucosa of patients with IBD are scarce. The main aim of this study is to evaluate the prevalence and viral load of common Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpes virus 6 in blood and mucosa of adult patients with endoscopic active IBD.

METHODS

From January to December 2014, ulcerative colitis and Crohn's disease patients with active endoscopic disease were consecutively enrolled. Subjects undergoing colonoscopy for colorectal cancer screening served as healthy controls (HCs). Paired blood and mucosal samples from each patient and HC were collected for EBV, CMV, and human herpes virus 6 quantitative real time polymerase chain reaction assessment of the viral load.

RESULTS

One hundred forty-five subjects were included; 95 IBD patients with active endoscopic disease (43 ulcerative colitis and 52 Crohn's disease) and 50 healthy subjects. CMV and EBV DNA were detected more frequently in the mucosa of patients with IBD compared with HCs (CMV P = 0.017; EBV P < 0.001), irrespective of IBD type. The frequency of human herpes virus 6 DNA detection both in the blood and in the mucosa did not differ between patients with IBD and HCs. EBV median viral load was similar in the inflamed and noninflamed mucosa was not affected by the use of immunomodulators and/or anti-tumor necrosis factor alpha agents, and did not correlate with endoscopic disease activity.

CONCLUSIONS

EBV, and to a lesser extent CMV, were more prevalent in patients with IBD than in HCs. Mucosal viral load was not influenced by the therapeutic regimen, did not differ between inflamed and noninflamed mucosa, and did not seem to be influenced by the endoscopic activity of the disease, suggesting that EBV may be more involved in the onset of IBD than in its severity and clinical evolution.

摘要

背景

尽管有一些证据表明某些病毒可能与炎症性肠病（IBD）的发病有关，但关于 IBD 患者血液和黏膜中病毒流行率和病毒载量的数据却很少。本研究的主要目的是评估成人内镜活动期 IBD 患者血液和黏膜中常见的 Epstein-Barr 病毒（EBV）、巨细胞病毒（CMV）和人类疱疹病毒 6 的流行率和病毒载量。

方法

从 2014 年 1 月到 12 月，连续纳入内镜活动期溃疡性结肠炎和克罗恩病患者。接受结肠镜检查筛查结直肠癌的患者作为健康对照（HCs）。从每位患者和 HCs 中采集配对的血液和黏膜样本，用于 EBV、CMV 和人类疱疹病毒 6 的定量实时聚合酶链反应评估病毒载量。

结果

共纳入 145 例患者，95 例 IBD 患者（43 例溃疡性结肠炎和 52 例克罗恩病）和 50 例健康对照。与 HCs 相比，IBD 患者的黏膜中更频繁地检测到 CMV 和 EBV DNA（CMV P = 0.017；EBV P < 0.001），无论 IBD 类型如何。IBD 患者和 HCs 的血液和黏膜中人类疱疹病毒 6 DNA 的检测频率均无差异。EBV 中位病毒载量在炎症和非炎症黏膜中相似，不受免疫调节剂和/或抗肿瘤坏死因子α药物的影响，且与内镜疾病活动度无关。