Yoshino Takuya, Nakase Hiroshi, Ueno Satoru, Uza Norimitsu, Inoue Satoko, Mikami Sakae, Matsuura Minoru, Ohmori Katsuyuki, Sakurai Takaki, Nagayama Satoshi, Hasegawa Suguru, Sakai Yoshiharu, Chiba Tsutomu
Department of Gastroenterology & Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Inflamm Bowel Dis. 2007 Dec;13(12):1516-21. doi: 10.1002/ibd.20253.
Studies suggest that cytomegalovirus (CMV) infection exacerbates ulcerative colitis (UC) refractory to immunosuppressive therapies. Early and accurate diagnosis of CMV infection is important for the treatment of UC. We evaluated the usefulness of quantitative real-time polymerase chain reaction (PCR) for detecting CMV infection in inflamed colonic mucosa of patients with UC refractory to immunosuppressive therapies.
From 2003 to 2006, 30 patients (mean age: 41 +/- 18 years; 14 men, 16 women) with UC refractory to immunosuppressive therapies were enrolled in the study. We evaluated CMV infection by CMV antigenemia, histologic examination, and quantitative real-time PCR for CMV using colonic mucosa and investigated the clinical outcomes of antiviral therapy.
CMV-DNA was detected only in the inflamed colonic mucosa in 17 (56.7%) of 30 patients. Of the 17 CMV-DNA-positive patients, 4 were positive for CMV antigenemia or inclusion bodies on histologic examination; of the 13 CMV-DNA-negative patients none was positive for CMV antigenemia or inclusion bodies. Of the 17 CMV-DNA-positive patients, 12 (70.6%) were treated with ganciclovir for 2 weeks and 10 patients went into remission. Two other patients required colectomy after antiviral therapy. In contrast, of the 13 CMV-DNA-negative patients 12 (92.3%) achieved remission after intensifying their immunosuppressive therapies.
Quantitative real-time PCR assay for detecting CMV-DNA is useful for early, accurate diagnosis of CMV infection in patients with UC refractory to immunosuppressive therapies, enabling prompt and appropriate treatment.
研究表明，巨细胞病毒（CMV）感染会使对免疫抑制疗法难治的溃疡性结肠炎（UC）病情加重。CMV感染的早期准确诊断对UC的治疗很重要。我们评估了定量实时聚合酶链反应（PCR）在检测对免疫抑制疗法难治的UC患者炎症性结肠黏膜中CMV感染的实用性。
2003年至2006年，30例对免疫抑制疗法难治的UC患者（平均年龄：41±18岁；男性14例，女性16例）纳入本研究。我们通过CMV抗原血症、组织学检查以及使用结肠黏膜进行CMV的定量实时PCR来评估CMV感染，并研究抗病毒治疗的临床结果。
30例患者中，17例（56.7%）仅在炎症性结肠黏膜中检测到CMV-DNA。在17例CMV-DNA阳性患者中，4例在组织学检查中CMV抗原血症或包涵体呈阳性；13例CMV-DNA阴性患者中，无一例CMV抗原血症或包涵体呈阳性。17例CMV-DNA阳性患者中，12例（70.6%）接受了更昔洛韦治疗2周，10例患者病情缓解。另外2例患者在抗病毒治疗后需要进行结肠切除术。相比之下，13例CMV-DNA阴性患者中，12例（92.3%）在强化免疫抑制治疗后病情缓解。
检测CMV-DNA的定量实时PCR检测法有助于对免疫抑制疗法难治的UC患者进行CMV感染的早期准确诊断，从而实现及时、恰当的治疗。
