溃疡性结肠炎合并EB病毒和巨细胞病毒感染的危险因素分析

Analysis of Risk Factors for Co-Infection of Ulcerative Colitis with Epstein-barr Virus and Cytomegalovirus

目的分析溃疡性结肠炎(ulcerative colitis,UC)患者合并EB病毒(epstein-barr virus,EBV)和巨细胞病毒(cytomegalovirus,CMV)感染的危险因素及与药物疗效的关系。方法回顾性收集2018年1月1日至2022年12月31日在昆明医科大学第一附属医院确诊为UC的280例患者的临床资料,单因素及多因素分析EBV的相关因素,单因素分析CMV感染的相关因素。结果单因素分析显示:高龄、重度疾病活动度、C-反应蛋白(C-reactive protein,CRP)、血小板(platelets,PLT)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、纤维蛋白降解产物(fibrin degradation products,FDP)、D-二聚体(D-dimer,D-D)、纤维蛋白原(fibrinogen,FIB)、血清钙卫蛋白(calprotectin,CAL)、Mayo内镜评分(Mayo endoscopic score,MES)均升高,白蛋白(albumin,ALB)下降、糖皮质激素使用是UC合并EBV感染的相关因素(P<0.05);高龄、重度疾病活动度、血红蛋白(haemoglobin,HB)、ALB下降、CRP升高是UC合并CMV感染的相关因素(P<0.05)。多因素分析显示高龄、重度疾病活动度是UC合并EBV感染的危险因素(P<0.05)。感染EBV者更易激素抵抗、免疫抑制剂无效和生物制剂失应答;感染CMV者更易免疫抑制剂无效和生物制剂失应答。结论高龄和重度疾病活动度是UC合并EBV感染的危险因素。UC患者感染EBV、CMV更易出现免疫抑制剂无效、生物制剂失应答;感染EBV也易出现激素抵抗。

Objective To analyze the risk factors of EB virus(EBV)and cytomegalovirus(CMV)infections in patients with ulcerative colitis(UC)and their relationship with drug efficacy.Methods A retrospective analysis was conducted on clinical data from 280 patients diagnosed with UC at the First Affiliated Hospital of Kunming Medical University between January 1,2018,and December 31,2022.Univariate and multivariate analyses were performed to identify the factors associated with EBV infections and univariate analyses was performed to identify the factors associated with CMV infections.Results Univariate analysis indicated that older age,severe disease activity,elevated C-reactive protein(CRP),increased platelet count(PLT),erythrocyte sedimentation rate(ESR),fibrin degradation products(FDP),D-dimer(D-D),fibrinogen(FIB),calprotectin(CAL),higher Mayo endoscopic scores(MES)index,decreased albumin(ALB),and corticosteroid use were linked to EBV infection(The average p value was<0.05).For CMV infection,significant factors included older age,severe disease activity,decreased hemoglobin(HB),ALB,elevated CRP(The average p value was<0.05).Multivariate analysis confirmed that older age and severe disease activity were risk factors for EBV infection(The average p value was<0.05).EBV-infected patients showed a higher likelihood of steroid resistance,ineffective immunosuppressants,and loss of response to biological therapies,while CMV-infected patients also faced challenges with the treatment response.Conclusion Older age and severe disease activity are the significant risk factors for EBV infection in UC patients.UC patients infected with EBV and CMV are more prone to immune suppressant ineffectiveness and biological agent failure to respond.People infected with EBV are also prone to hormone resistance.