巨细胞病毒在炎症性肠病中的临床意义及其诊治策略
投稿时间:2016-07-09  修订日期:2016-08-23  点此下载全文
引用本文:贾国葆,吴建胜,吴亮,黄智铭,陈向荣.巨细胞病毒在炎症性肠病中的临床意义及其诊治策略[J].医学研究杂志,2017,46(3):102-105
DOI: 10.11969/j.issn.1673-548X.2017.03.026
摘要点击次数: 1082
全文下载次数: 672
作者单位E-mail
贾国葆 325000 温州, 温州医科大学附属第一医院消化科  
吴建胜 325000 温州, 温州医科大学附属第一医院消化科  
吴亮 325000 温州, 温州医科大学附属第一医院病理科  
黄智铭 325000 温州, 温州医科大学附属第一医院消化科  
陈向荣 325000 温州, 温州医科大学附属第一医院消化科 jgb93699@21cn.com 
基金项目:温州市科技局基金资助项目(Y20130061)
中文摘要:目的 探讨巨细胞病毒(cytomegalovirus,CMV)在炎症性肠病(inflammatory bowel disease,IBD) 临床意义及其诊治策略。方法 从IBD患者[其中溃疡性结肠炎(UC)39例,克罗恩病(CD)15例]及对照组患者(肠易激综合征患者55例)血液中检测CMV抗体,并从 UC患者(其中手术标本11例,肠镜下活检标本39例),以及克罗恩病患者(其中手术标本4例,肠镜下活检标本15例),及对照组肠镜下活检标本55例,检测CMV抗体及CMV包涵体。结果 IBD伴CMV感染肠道病变更广泛,多为全结肠炎或右半结肠炎。IBD组CMV抗体阳性率高于对照组(P<0.01),重度、激素难治性UC组全身激素治疗多于非激素难治性UC组(P<0.05),重度、激素难治性UC组CMV IgM抗体阳性率高于非重度和(或)激素难治性UC组(P<0.05),手术UC组血清CMV抗体阳性率高于非手术IBD组(P<0.01),重度、激素难治性UC组CMV包涵体(HE染色)阳性率与非重度和(或)激素难治性UC组比较,差异无统计学意义(P>0.05),重度、激素难治性UC组CMV包涵体(IHC)阳性率高于非重度和(或)激素难治性UC组(P<0.01),手术UC组CMV包涵体(IHC)阳性率高于非手术IBD组(P<0.01),重度或难治性IBD常合并或继发有CMV感染经适当的抗病毒治疗可明显改善病情。结论 血清学和组织学(特别是IHC) 联合检测可提高CMV感染诊断的准确性。在重症或激素难治性UC患者检测CMV是特别重要的,如果检测到CMV感染,更昔洛韦抗病毒治疗应立即开始,逐渐减弱激素剂量,并停用免疫抑制剂。
中文关键词:巨细胞病毒  炎症性肠病  溃疡性结肠炎  克罗恩病
 
Clinical Significance and Management of Cytomegalovirus Infection in Patients with Inflammatory Bowel Disease
Abstract:Objective To explore the clinical significance and management of cytomegalovirus infection in patients with inflammatory bowel disease (IBD). Methods All patients who were divided into the case group (IBD 54cases)and the control group(irritable bowel syndrome 55cases) underwent a blood sample extraction and a colonoscopy. Laboratory studies included CMV-IgG and CMV-IgM antibodies. Colonic biopsies were obtained by colonoscopy.Surgical specimens taken from IBD patients were examined for CMV infection. CMV infection rates were evaluated and a comparison of clinical parameters was made between CMV-positive and CMV-negative patients.The diagnosis was confirmed by a viral-like prodrome, a positive CMV IgM titer and /or presence of higher avidity IgG antibodies to CMV in the plasma, and /or immunohistological detection of CMV positive cells in colonic mucosa and /or surgical specimens. Results IBD patients with CMV-positive were more likely to pancolitis as compared to CMV-negative ones. CMV involvement occurs more frequent in the right colon. Anti-CMV IgM positive rate was more frequent in active steroid-refractory UC versus the control group(P<0.01). Anti-CMV IgM was more frequent in severe UC or refractory UC than mild UC or moderate UC(P<0.05). Anti-CMV IgM was more frequent in need operative UC group than non operative UC group(P<0.05). CMV inclusions on H&E staining positive rate in severe UC or refractory UC was no different with mild UC or moderate UC(P>0.05).CMV inclusions on IHC was more frequent in severe UC or refractory UC than mild UC or moderate UC(P<0.05). CMV inclusions on IHC was more frequent in need operative UC group than non operative IBD group(P<0.05). Treatment with ganciclovir gives rapid clinical, biochemical, and haematological response. Conclusion Serological and histological (especially IHC) combined detection can improve the accuracy of diagnosis of CMV infection. Detection of CMV was particularly important in patients with severe or hormone refractory UC, If CMV infection was detected, antiviral therapy with ganciclovir should be started immediately by tapering the steroid dose and discontinuing immunomodulators.
keywords:Cytomegalovirus  Inflammatory bowel disease  Ulcerative colitis  Crohn's disease
查看全文  查看/发表评论  下载PDF阅读器

京公网安备 11010502037822号