Objective. Despite the use of immunosuppressive drugs, recurrent and de novo inflammatory bowel disease (IBD) can develop after orthotopic liver transplantation (OLT). Cytomegalovirus (CMV) infection has been suggeste...Objective. Despite the use of immunosuppressive drugs, recurrent and de novo inflammatory bowel disease (IBD) can develop after orthotopic liver transplantation (OLT). Cytomegalovirus (CMV) infection has been suggested to play a role in the pathogenesis of IBD. The aim of this study was to investigate the role of CMV infection in the development of IBD after OLT. Material and methods. All 84 patients who underwent transplantation for primary sclerosing cholangitis (PSC) or autoimmune hepatitis (AIH) in our center between May 1987 and June 2002 and who survived the first year after transplantation were included in the study. Diagnosis of active CMV infection was made using the pp65- antigenemia assay. Results. Thirty- one of the 84 patients (37% ) had IBD prior to OLT. Eighteen patients (21% ) experienced IBD after OLT, either as flare- up (n = 12) or de novo (n = 6), at a median of 1.4 years (range 0.3 to 6.3) after OLT Forty- eight percent of all patients experienced CMV infection after OLT, at a median of 27 days (range 8 to 193). CMV infection was primary in half the patients. At 1, 3, and 5 years after OLT, active IBD- free survival without CMV infection was 91, 88, and 88% , respectively. With CMV infection these figures were 93, 82, and 67% . De novo IBD was seen only in those who had experienced a CMV infection (p = 0.02). Conclusions. In patients transplanted for end- stage PSC or AIH, active IBD, especially de novo IBD, occurred more often in patients who experienced CMV infection in the postoperative period. This finding supports a pathogenic role for CMV in the development of IBD.展开更多
人巨细胞病毒（ human cytomegalovirus,HCMV）属β疱疹病毒亚科,人群对其普遍易感,成人HCMV感染率可达30％～100％[1].在机体免疫功能正常时,HCMV常呈隐性或潜伏感染,而在免疫功能低下或缺陷时（如移植受者、艾滋病患者等）常呈显性感...人巨细胞病毒（ human cytomegalovirus,HCMV）属β疱疹病毒亚科,人群对其普遍易感,成人HCMV感染率可达30％～100％[1].在机体免疫功能正常时,HCMV常呈隐性或潜伏感染,而在免疫功能低下或缺陷时（如移植受者、艾滋病患者等）常呈显性感染.HCMV感染后不仅可通过直接的致细胞病变作用,引起HCMV症状和侵入性疾病（如HCMV肺炎、肝炎、胃肠炎、脑炎等）,还可通过间接的宿主依赖的免疫病理作用,引起移植排斥、移植物损伤,诱发机会性感染等[2].HCMV感染可诱导激活其他人疱疹病毒（ human herpesviruses,HHV）的活动性感染,如HHV-6、HHV-7、EB病毒（EBV）等[2],而有关其对多瘤病毒[多瘤BK病毒（BK virus,BKV）、多瘤JC病毒（JC virus,JCV）、乙型肝炎病毒（hepatitis B virus,HBV）、丙型肝炎病毒（Hepatitis C virus,HCV）]机会性感染的影响研究甚少.因此,本研究通过比较肾移植患者HCMV感染组和非感染组移植术后HCMV、BKV、JCV、HBV、HCV感染率的差别,来初步探究HCMV感染对上述病毒机会性感染的影响.展开更多
文摘Objective. Despite the use of immunosuppressive drugs, recurrent and de novo inflammatory bowel disease (IBD) can develop after orthotopic liver transplantation (OLT). Cytomegalovirus (CMV) infection has been suggested to play a role in the pathogenesis of IBD. The aim of this study was to investigate the role of CMV infection in the development of IBD after OLT. Material and methods. All 84 patients who underwent transplantation for primary sclerosing cholangitis (PSC) or autoimmune hepatitis (AIH) in our center between May 1987 and June 2002 and who survived the first year after transplantation were included in the study. Diagnosis of active CMV infection was made using the pp65- antigenemia assay. Results. Thirty- one of the 84 patients (37% ) had IBD prior to OLT. Eighteen patients (21% ) experienced IBD after OLT, either as flare- up (n = 12) or de novo (n = 6), at a median of 1.4 years (range 0.3 to 6.3) after OLT Forty- eight percent of all patients experienced CMV infection after OLT, at a median of 27 days (range 8 to 193). CMV infection was primary in half the patients. At 1, 3, and 5 years after OLT, active IBD- free survival without CMV infection was 91, 88, and 88% , respectively. With CMV infection these figures were 93, 82, and 67% . De novo IBD was seen only in those who had experienced a CMV infection (p = 0.02). Conclusions. In patients transplanted for end- stage PSC or AIH, active IBD, especially de novo IBD, occurred more often in patients who experienced CMV infection in the postoperative period. This finding supports a pathogenic role for CMV in the development of IBD.
文摘人巨细胞病毒（ human cytomegalovirus,HCMV）属β疱疹病毒亚科,人群对其普遍易感,成人HCMV感染率可达30％～100％[1].在机体免疫功能正常时,HCMV常呈隐性或潜伏感染,而在免疫功能低下或缺陷时（如移植受者、艾滋病患者等）常呈显性感染.HCMV感染后不仅可通过直接的致细胞病变作用,引起HCMV症状和侵入性疾病（如HCMV肺炎、肝炎、胃肠炎、脑炎等）,还可通过间接的宿主依赖的免疫病理作用,引起移植排斥、移植物损伤,诱发机会性感染等[2].HCMV感染可诱导激活其他人疱疹病毒（ human herpesviruses,HHV）的活动性感染,如HHV-6、HHV-7、EB病毒（EBV）等[2],而有关其对多瘤病毒[多瘤BK病毒（BK virus,BKV）、多瘤JC病毒（JC virus,JCV）、乙型肝炎病毒（hepatitis B virus,HBV）、丙型肝炎病毒（Hepatitis C virus,HCV）]机会性感染的影响研究甚少.因此,本研究通过比较肾移植患者HCMV感染组和非感染组移植术后HCMV、BKV、JCV、HBV、HCV感染率的差别,来初步探究HCMV感染对上述病毒机会性感染的影响.
