Inflammatory bowel disease:definition,epidemiology,etiologic aspects,andimmunogenetic studies

作     者：XIA Bing JBA Crusius SGM Meuwissen AS Pe a 

作者机构：Department of GastroenterologyThe Second Affiliated HospitalHubei Medical UniversityWuhan 430071China Laboratory of Gastrointest in al ImmunogeneticsMedical FacultyFree University Ams terdam1081 BT Ams terdamThe Ne therlands 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志(英文版))

年 卷 期：1998年第4卷第5期

页      面：83-95页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：inflammatory bowel disease/epidemiology inflammatory bowel disease/etiology inflammatory bowel disease/genetics inflammatory bowel disease/immunology 

摘      要：The etiology of IBD remains unclear. Environmental factors, a genetic predisposition and a disturbed immunological response all contribute to the development of the disease. Even though pathogens have not been identified as a cause of IBD, persistent infections are highly suspected, including Mycobacterium paratuberculosis and measles virus in CD, and an unknown bacterial infection and/ or bacterial products in UC. Smoking has been suggested to be a strong risk factor in CD, and in determining the clinical course of UC and CD. Disturbances of the mucosal immune system and an imbalance of immune regulation presented by cellular and/ or humoral abnormalities as well as functions of pro-inflammatory cytokines and anti-inflammatory cytokines, and other mediators were observed in IBD patients and are considered to be fundamental to the pathogenesis of IBD. Because of the multiplicity and complexity of the interactions of all these elements, it is difficult to distinguish between primary and secondary, and pathogenic and non-pathogenic phenomena[248]. With the development of transgenic and knockout rodent models, it is possible to define the critical immune elements necessary to develop IBD. Recent studies demonstrated that mucosal homeostasis is important and a defective mucosal barrier may allow unrestrained uptake of luminal antigens and pro-inflammatory molecules and thus initiate immune responses. Some evidence for an imbalance of pro-and anti-inflammatory cytokines and of Th1/Th2 lymphocytes have been found in chronic intestinal inflammation. pANCA are present in more than 70% of UC patients, but their role as a subclinical marker of UC needs to be confirmed. As to genetic factors, epidemiological studies have demonstrated the influence of genetic factors on the development of IBD by phenomena such as ethnic variations, familial aggregation, monozygotic twins versus dizygotic twins, and first degree relatives versus spouses. A genetic influence weights more for CD t