Long-term outcome of inflammatory bowel diseases with cytomegalovirus colitis: effect of antiviral treatment
Long-term outcome of inflammatory bowel diseases with cytomegalovirus colitis: effect of antiviral treatment
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DOI：
10.1097/meg.0000000000000175
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发表时间：
2014-10-01
影响因子：
2.1
通讯作者：
Ardizzone, Sandro
中科院分区：
文献类型：
--
作者：
Maconi, Giovanni;Lombardini, Marta;Ardizzone, Sandro
目的巨细胞病毒（CMV）再激活在炎症性肠病（IBD）预后中的作用尚不清楚。CMV感染的治疗仍不稳定，特别是血液中病毒载量略高于正常值或结肠活检中阳性细胞很少的患者。这项回顾性队列研究报告了38例活动性IBD患者CMV感染的长期结果，其中13例接受了抗病毒治疗。患者和方法30例溃疡性结肠炎（UC）和8例克罗恩氏结肠炎患者活动性结肠炎和CMV感染，通过组织学和免疫组织化学和/或CMV抗原试验或CMV DNA试验检测至少一种CMV包涵体来诊断。回顾了他们出院后6个月和1年的临床病史。出院时的临床缓解和需要新治疗或结肠切除术的复发被认为是研究的主要结局。治疗和未治疗的患者的特点进行了比较，使用Fisher精确检验和Student t-test.Results所有患者都表现出罕见的CMV夹杂物，只有三个有阳性的血液CMV PCR。13名患者接受了抗病毒治疗，而25名患者没有接受治疗。住院期间无患者接受结肠切除术。12个月累积的临床复发率，需要新的治疗或结肠切除术是23%的抗病毒治疗的患者和50%的未经治疗的患者（P = 0.165）。然而，在UC患者和激素依赖性/难治性疾病患者中，抗病毒治疗与12个月时显著较高的临床缓解率相关（77.8vs.45%，P = 0.049; 77.8vs.19.4%，P = 0.038）。在急性期治疗期间，抗病毒治疗似乎在短期内具有边际影响，但在UC和类固醇依赖性/难治性疾病患者中，其在维持缓解长达1年的随访中可能具有一些有益作用。(C)2014年威科健康断竖条利平科特威廉姆斯&威尔金斯。
Objective The role of cytomegalovirus (CMV) reactivation in the outcome of inflammatory bowel diseases (IBDs) is unclear. Uncertainties remain on the treatment of CMV infection, especially in patients with a viral load just above the normal value in the blood or with very few positive cells in colonic biopsies. This retrospective cohort study reports the long-term outcome of 38 active IBD patients with CMV infection, 13 of whom received an antiviral treatment.Patients and methods Thirty patients with ulcerative colitis (UC) and eight patients with Crohn's colitis with active colitis and CMV infection, diagnosed by detection of at least one CMV inclusion by histology and immunohistochemistry and/or with the CMV antigen test or the CMV DNA test, were studied. Their clinical history at 6 months and up to 1 year following hospital discharge was reviewed. Clinical remission at hospital discharge and recurrences requiring new treatments or colectomy were considered major outcomes of the study. The features of treated and untreated patients were compared using the Fisher exact test and the Student t-test.Results All patients showed rare CMV inclusions, and only three had positive blood CMV PCR. Thirteen patients received antiviral treatment, whereas 25 patients did not. No patient underwent colectomy during the hospitalization. The 12-month cumulative rate of clinical relapse requiring new treatment or colectomy was 23% in patients treated with antivirals and 50% in untreated patients (P = 0.165). However, in patients with UC and in those with steroid-dependent/refractory disease, antiviral treatment was associated with a significantly higher clinical remission rate at 12 months (77.8 vs. 45%, P = 0.049, and 77.8 vs. 19.4%, P = 0.038, respectively).Conclusion In IBD patients with active CMV colitis, antiviral treatment seems to have a marginal impact in the short term, during the treatment of the acute phase, but it may have some beneficial effect in maintaining remission up to 1 year of follow-up in patients with UC and steroid-dependent/refractory disease. (C) 2014 Wolters Kluwer Health broken vertical bar Lippincott Williams & Wilkins.