Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago 60611, IL, USA.
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore 21287, MD, USA.
Hum Pathol. 2018 Dec;82:187-192. doi: 10.1016/j.humpath.2018.08.001. Epub 2018 Aug 16.
A potential role for viral infections has been implicated in inflammatory bowel disease (IBD) unresponsive to medical treatment. It is well known that Epstein-Barr virus (EBV) infection can elicit a brisk mononuclear response in the gastrointestinal tract. The aim of this study was to further evaluate the role of EBV in patients with refractory IBD and compare them with nonrefractory IBD cases. Surgically resected colonic specimens from 67 patients with refractory IBD (62 with ulcerative colitis, 3 patients with Crohn disease, and 2 patients with indeterminate colitis) were retrieved. Twelve colectomy specimens from patients with ulcerative colitis who had undergone resections for dysplasia or endometriosis were included as controls. Highly sensitive EBV-encoded small RNA1 (EBER-1) in situ hybridization was performed on a representative block from each specimen. EBER-1 reactivity was graded as absent, focal, or diffuse. EBV was detected in 60% (40/67) of patients with refractory IBD compared with 25% (3/12) of the control group (P < .05). Focal EBER-1 positivity was present in 45% of cases of refractory IBD compared with 25% of controls. Diffuse EBER-1 reactivity was seen in 15% of cases of refractory IBD (10/67); none of the samples from the control group contained diffuse EBER-1 positivity. There was a positive correlation between EBER positivity and depth of inflammation and mucosal ulceration in patients with refractory IBD. Our findings suggest a potential role for EBV infection in patients with refractory IBD.
病毒感染在对药物治疗无反应的炎症性肠病 (IBD) 中可能发挥作用。众所周知，EB 病毒 (EBV) 感染可在胃肠道引起剧烈的单核细胞反应。本研究旨在进一步评估 EBV 在难治性 IBD 患者中的作用，并将其与非难治性 IBD 病例进行比较。从 67 例难治性 IBD 患者（62 例溃疡性结肠炎、3 例克罗恩病和 2 例不确定结肠炎）中获取手术切除的结肠标本。纳入 12 例因异型增生或子宫内膜异位症而行切除术的溃疡性结肠炎患者的 12 例结肠切除标本作为对照。对每个标本的代表性组织块进行高度敏感的 EBV 编码的小 RNA1（EBER-1）原位杂交。EBER-1 反应性被评为无、局灶或弥漫。与对照组 25%（3/12）相比，难治性 IBD 患者中 EBV 检出率为 60%（40/67）（P<.05）。难治性 IBD 病例中局灶性 EBER-1 阳性率为 45%，对照组为 25%。难治性 IBD 病例中弥漫性 EBER-1 反应性为 15%（10/67）；对照组中无一例标本存在弥漫性 EBER-1 阳性。难治性 IBD 患者中 EBER 阳性与炎症深度和黏膜溃疡呈正相关。我们的研究结果表明 EBV 感染在难治性 IBD 患者中可能发挥作用。
