Effect of intensive granulocyte and monocyte adsorptive apheresis in patients with ulcerative colitis positive for cytomegalovirus
Effect of intensive granulocyte and monocyte adsorptive apheresis in patients with ulcerative colitis positive for cytomegalovirus
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DOI：
10.1016/j.crohns.2012.12.003
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发表时间：
2013-11-01
影响因子：
8
通讯作者：
Ashida, Kiyoshi
中科院分区：
文献类型：
--
作者：
Fukuchi, Takumi;Nakase, Hiroshi;Ashida, Kiyoshi
背景与目的：巨细胞病毒(CMV)可加重免疫抑制治疗无效的溃疡性结肠炎(UC)。然而，巨细胞病毒在UC患者中重新激活的条件尚不清楚。此外，巨细胞病毒阳性UC的诊断和治疗策略尚未建立。粒细胞和单核细胞吸附分离(GMAA)是治疗UC的一种天然生物疗法，去除产生炎性细胞因子的粒细胞/巨噬细胞。我们观察了CMV阳性的活动期UC患者的结肠CMV复发率和GMAA的疗效。取活检标本和/或组织学检查，用实时聚合酶链式反应(PCR)检测结肠CMV的激活。所有患者均接受强化GMAA治疗(每周2次)。结果：51例患者中，15例(29.4%)诊断为CMV阳性。巨细胞病毒阳性和阴性的UC患者强化化疗后的临床缓解率分别为73.3%和69.4%，P=0.781。这两组患者实现粘膜愈合的比例也是相似的。所有CMV阳性的UC患者在完成强化治疗后1周达到临床缓解，CMV-DNA转为阴性。结论：肠道炎症可能会在未接受CS治疗的活动期UC患者中触发CMV重新激活。对于CMV阳性的活动性UC，GMAA可能是一种有前景的选择。(C)2012年欧洲克罗恩和结肠炎组织。爱思唯尔出版，版权所有。
Background and aim: Cytomegalovirus (CMV) exacerbates ulcerative colitis (UC) refractory to immunosuppressive therapies. The conditions under which CMV reactivation occurs in patients with UC, however, is unclear. In addition, the diagnostic and treatment strategies for UC positive for CMV have not been established. Granulocyte and monocyte adsorptive apheresis (GMAA) is natural biological therapy for UC in which the granulocytes/macrophages producing inflammatory cytokines are removed. We investigated the rate of colonic CMV reactivation and the efficacy of GMAA in active UC patients positive for CMV without concomitant corticosteroid (CS) therapy.Methods: Fifty-one active UC patients without concomitant CS therapy were enrolled. Colonic CMV reactivation was examined by real-time polymerase chain reaction (PCR) using biopsy specimen and/or histological examination. All patients were treated with intensive GMAA (twice per week). Rates of clinical remission and mucosal healing were compared between UC patients positive and negative for CMV.Results: Of 51 patients, 15 (29.4%) were diagnosed as CMV positive. The clinical remission rates following intensive GMAA did not differ between UC patients positive and negative for CMV (73.3% vs 69.4%, p=0.781). Proportion of patients achieving mucosal healing was also similar between these two groups. CMV-DNA became negative in all UC patients positive for CMV who achieved clinical remission 1 week after completion of intensive GMAA.Conclusions: Intestinal inflammation might trigger CMV reactivation in a subpopulation of active UC patients without CS treatment. GMAA could be a promising option for active UC positive for CMV. (C) 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.