Wakefield A J, Ekbom A, Dhillon A P, Pittilo R M, Pounder R E
Inflammatory Bowel Disease Study Group, Royal Free Hospital School of Medicine, London, England.
Gastroenterology. 1995 Mar;108(3):911-6. doi: 10.1016/0016-5085(95)90467-0.
The Inflammatory Bowel Disease Study Group at the Royal Free Hospital School of Medicine has tested the hypothesis that the primary pathological abnormality in Crohn's disease is in the mesenteric blood supply. Early morphological studies involved arterial perfusion-fixation and either resin casting and scanning electron microscopy or vascular immunostaining of resected intestine affected by Crohn's disease. Granulomatous and lymphocytic damage to intramural blood vessels, even in macroscopically normal areas, was observed. We put forward possible mechanisms by which a chronic ischemic process might account for many of the idiosyncracies of Crohn's disease. It was proposed that persistent viral infection of the mesenteric microvascular endothelium might underly this vasculitic process; based on certain behavioral characteristics of measles virus, including its tropism for the submucosal endothelium of the intestine, this agent was investigated further. This report reviews the preliminary evidence from both epidemiological and basic scientific data for persistent measles virus in the intestine of patients with Crohn's disease. Possible mechanisms for virus persistence and subsequent reactivation are discussed. In conclusion, we believe that Crohn's disease may be a chronic granulomatous vasculitis in reaction to a persistent infection with measles virus within the vascular endothelium. This granulomatous inflammation, perhaps aggravated by either a hypercoagulable state or mechanical stress, results in the clinical features of Crohn's disease.
皇家自由医院医学院炎症性肠病研究小组对克罗恩病的主要病理异常在于肠系膜血液供应这一假说进行了验证。早期的形态学研究包括动脉灌注固定以及对受克罗恩病影响的切除肠段进行树脂铸型和扫描电子显微镜检查或血管免疫染色。即使在宏观上正常的区域，也观察到了壁内血管的肉芽肿性和淋巴细胞性损伤。我们提出了慢性缺血过程可能解释克罗恩病诸多特性的可能机制。有人提出，肠系膜微血管内皮的持续性病毒感染可能是这种血管炎过程的基础；基于麻疹病毒的某些行为特征，包括其对肠道黏膜下内皮的嗜性，对该病原体进行了进一步研究。本报告回顾了来自流行病学和基础科学数据的关于克罗恩病患者肠道中持续性麻疹病毒的初步证据。讨论了病毒持续存在及随后再激活的可能机制。总之，我们认为克罗恩病可能是一种针对血管内皮中麻疹病毒持续性感染的慢性肉芽肿性血管炎。这种肉芽肿性炎症，可能因高凝状态或机械应力而加重，导致了克罗恩病的临床特征。
