Shagil'dian V I, Tishkevich O A, Parkhomenko Iu G, Morozova S V, Tishkevich I M, Gruzdev B M, Danilova T V, Golokhvastova E L
Ter Arkh. 2005;77(11):14-20.
To study clinical and morphological characteristics of gastrointestinal cytomegalovirus (CMV) infection in HIV-infected subjects.
The examination of 70 HIV-infected subjects (all of them had secondary diseases, AIDS, CMV infection in the gastrointestinal tract; mean age 31.2 +/- 1.4 years) observed from 1993-2005 included conduction of flow cytofluorimetry (to assess immunity), esophagogastroduodenoscopy, colonoscopy, PCR (to assay CMV DNA in blood leukocytes), examination of biopsy and autopsy samples for CMV DNA and other pathogens of opportunistic diseases). There were 55 lethal outcomes. In autopsy, a total macroscopic and microscopic examination of the gastrointestinal tract was made. Serial histotopographic sections were studied with a wide spectrum of histological stains.
CMV gastrointestinal lesion was diagnosed in 38.9% of 180 HIV-infected subjects who had stomatitis, pharyngitis, esophagitis, gastritis, enteritis, enterocolitis or colitis. Diagnostic criteria of viral lesion were high blood concentrations of CMV DNA, the presence of cytomegalocells, CMV DNA in biopsy or autopsy material.
CMV infection manifested with severe pain, loss of weight, weakness, remitting fever. Gastrointestinal lesions were erosive-ulcerous or ulceronecrotic. The following pathogenetic chain of CMV infection course in the gastrointestinal tract was established: vasculitis--microcirculatory disorders--segmental ischemia--necrosis with inflammatory infiltration and CMV transformation of the cells--fibrosing--cicatricial transformation of the organ wall. Developing sclerosis due to CMV involvement of the intestine may promote cancer, but this should be proved in further studies. CMV gastrointestinal infection was successfully treated by cimeven (ganciclovir) and valcit (valganciclovir). The effect was achieved in 91% cases.
研究人类免疫缺陷病毒（HIV）感染者胃肠道巨细胞病毒（CMV）感染的临床和形态学特征。
对1993年至2005年观察的70例HIV感染者（均患有继发性疾病、艾滋病、胃肠道CMV感染；平均年龄31.2±1.4岁）进行了流式细胞荧光术检查（以评估免疫力）、食管胃十二指肠镜检查、结肠镜检查、聚合酶链反应（以检测血液白细胞中的CMV DNA）、对活检和尸检样本进行CMV DNA及其他机会性疾病病原体检查。有55例死亡病例。尸检时对胃肠道进行了全面的宏观和微观检查。用多种组织学染色方法研究了连续的组织拓扑切片。
在180例患有口腔炎、咽炎、食管炎、胃炎、肠炎、小肠结肠炎或结肠炎的HIV感染者中，38.9%被诊断为CMV胃肠道病变。病毒病变的诊断标准为血液中CMV DNA浓度高、存在巨细胞、活检或尸检材料中有CMV DNA。
CMV感染表现为严重疼痛、体重减轻、虚弱、弛张热。胃肠道病变为糜烂性溃疡或溃疡坏死性。确立了CMV在胃肠道感染过程的以下发病机制链：血管炎——微循环障碍——节段性缺血——伴有炎症浸润和细胞CMV转化的坏死——纤维化——器官壁的瘢痕化转化。由于CMV累及肠道而发生的硬化可能促进癌症发生，但这有待进一步研究证实。CMV胃肠道感染用西美韦（更昔洛韦）和缬昔洛韦成功治疗。91%的病例取得了疗效。
