难治性溃疡性结肠炎与巨细胞病毒的关系

Relationship between refractory ulcerative colitis and cytomegalovirus infection

目的:探讨难治性溃疡性结肠炎(ulcerativecolitis,UC)与巨细胞病毒(cytomegaoviyns,CMV)感染的关系,提高对该病的认识和治疗水平.方法:收集2000-07/2009-02在天津医科大学总医院诊治的76例溃疡性结肠炎患者.根据是否使用激素及其治疗效果,将患者分为有效组和难治组,对两组患者进行相关临床资料的比较,同时对其内镜活检组织进行免疫组织化学染色.结果:CMV-negative患者共65例,其中男40例,女25例;CMV-positive患者共11例,其中男3例,女8例.CMV-positive患者中,难治组为9例,有效组为2例,两组之间的差异有统计学意义,且出现高热,颈淋巴结肿大,脾肿大等症状和体征的IBD患者与CMV-positive组有关.内镜及病理表现,难治组与有效组相似.在此研究病例中,临床表现比较多样,仍以腹泻腹痛为主,其中2例因出现并发症而行结肠切除术,均在CMV-positive组.结论:难治性溃疡性结肠炎与CMV感染有一定关系,CMV可以使难治性溃疡性结肠炎的病程变复杂,出现激素抵抗,但进行抗病毒治疗能否改善激素的敏感性,有待进一步考证.

AIM：To explore the relationship between refractory ulcerative colitis（UC） and cytomegalovirus（CMV）infection. METHODS：Seventy-six patients with inflammatory bowel disease（IBD）diagnosed at Tianjin General Hospital from July 2000 to February 2009 were included in the study.According to the use of corticosteroid or not and therapeutic effect,these patients were divided into two groups：effective group and refractory group. Cytomegalovirus（CMV）infection of the colon was evaluated by immunohistochemistry. RESULTS：Eleven patients,including three males and eight females,were positive for CMV, while sixty-five patients,including forty males and twenty-five females,were negative for CMV.Of CMV-positive patients,nine belonged to the refractory group,and two belonged to the effective group.The percentage of CMV-positive patients was significantly higher in the refractory group than in the effective group（P〈0.05）.CMV-positive patients often suffered from high fever,cervical lymphadenopathy,and splenomegaly.No significant difference was noted in endoscopic and pathological manifestations in patients between the effective group and refractory group.Despite diverse clinical manifestations,abdominal pain and diarrhea were main ones observed in this study.Two CMV-positive patients underwent colectomy due to the occurrence of complication. CONCLUSION：Refractory inflammatory bowel disease is related to CMV infection.The course of IBD may become more complicated in the presence of CMV infection.It remains to be investigated whether antiviral therapy can improve the sensitivity to corticosteroid therapy in IBD patients with CMV infection.