EB病毒感染在間質性膀胱炎中所扮演的角色
張嘉峰、郭漢崇
花蓮慈濟醫院 泌尿部
EB virus in interstitial cystitis/bladder pain syndrome – an immunochemical study
Jia-Fong Jhang, Hann-Chorng Kuo
Department of Urology, Haulien Tzu Chi Hospital.
Purpose: Pathogenesis of ulcer type interstitial cystitis/bladder pain syndrome (IC/BPS) might be different from the non-ulcer IC/BPS. Previous study revealed subepithelial lymphoplasmacytic infiltration with focal lymphocyte aggregation in the bladder of ulcer IC/BPS. However, the etiology is still unknown. The aim of current study is to investigate the role of EB virus in the pathogenesis of IC/BPS, including ulcer and non-ulcer type.
Materials and Methods: Thirteen patients with IC/BPS who were admitted to our ward for partial cystectomy and augmentation enterocystoplasty were enrolled into this study. Among the 13 patients, ten were ulcer IC/BPS and the other 3 patients were non-ulcer IC/BPS. The bladder specimens were obtained during the operation and sent to our pathology department for immunochemical staining for EB virus. Immunochemical staining cell markers CD3 for T lymphocyte and CD20 for B lymphocyte were also performed in the ulcer IC/BPS bladder. Blood samples for EB virus serological markers were obtained in the patients with positive immunochemical finding, including EB-VCA IgG, IgM, EBEA IgG and EBNA IgG. Twenty mild IC/BPS patients who were admitted for cystoscopic hydrodistention were also enrolled. Twelve female patients who were admitted for anti-incontinence surgery were also enrolled and were considered as normal controls. Bladder mucosa biopsies were performed during the procedure, and the biopsy specimens were sent to the pathology department for immunochemical staining for EB virus.
Results: Among the 13 IC/BPS bladder specimens from partial cystectomy, immunochemical staining revealed EB virus positive in 7 patients (7/13=53.8%). Five of the 7 patients were ulcer type IC/BPS, and the others 2 patients were non-ulcer IC/BPS. The EB virus positive rate was 5/10=50% in the ulcer IC/BPS bladder specimens, and was 2/3=66% in the non-ulcer IC/BPS bladder. None of the 20 IC/BPS or 12 normal control bladder biopsies was positive for EB virus. The immunochemical staining also showed CD3 positive in the EB virus positive cells. The serological tests for EV virus revealed EB-VCA IgG and EBNA positive in all patients. The serum EBNA IgG was positive in only one patient, and EB-VCA IgM was all negative. The clinical symptoms severity was not significantly different between IC/BPS patients with or without EB virus positive
Conclusions: EB virus infection in bladder T cells was found in patients with severe IC/BPS. EB virus infection and following immune response may involve the pathogenesis in IC/BPS patients with severe symptoms.