Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Bioinformatics Bldg., CB#7080, Chapel Hill, NC, 27599, USA.
Dig Dis Sci. 2010 Apr;55(4):1053-8. doi: 10.1007/s10620-010-1146-0. Epub 2010 Feb 18.
A severe flare of colitis in patients with IBD treated with immunosuppressive therapy may be complicated by an underlying CMV infection. The aim of this pilot study was to investigate the diagnostic efficacy of quantitative polymerase chain reaction (PCR) to detect CMV DNA in stool samples of IBD patients.
Twenty-one patients with a severe flare of IBD, incompletely responding or refractory to either steroids or immunosuppressive agents, were included in the study. Nineteen patients completed the study according to the protocol undergoing an endoscopy with biopsies and collection of stool samples. Biopsy and stool samples were qualitatively and quantitatively analyzed for CMV DNA using real-time PCR.
Thirty-two percent (6/19) of the patients had detectable CMV DNA in colonic biopsies and in five (83%) of those patients CMV DNA was detected in the stool. Thirteen patients had negative findings for CMV DNA in biopsy and stool samples. The sensitivity, specificity, and accuracy of the PCR-based stool test for detection of CMV DNA compared to PCR-based detection of CMV in mucosal biopsies were 83, 93, and 90%, respectively.
The pilot study suggests a high accuracy of this non-invasive testing method to detect CMV DNA in stool samples as compared to mucosal biopsies. This approach may offer a non-endoscopic testing modality for underlying CMV infection in patients with a severe flare of IBD, which could also be applied more broadly to determine the prevalence of CMV infections in patients with IBD.
接受免疫抑制治疗的 IBD 患者出现严重结肠炎发作时，可能并发潜在的 CMV 感染。本研究旨在探讨定量聚合酶链反应（PCR）检测 IBD 患者粪便样本中 CMV DNA 的诊断效果。
21 例 IBD 严重发作、对类固醇或免疫抑制剂反应不完全或耐药的患者纳入本研究。19 例患者按方案完成研究，进行内镜检查和活检及粪便样本采集。使用实时 PCR 对活检和粪便样本进行 CMV DNA 的定性和定量分析。
32%（6/19）的患者在结肠活检中检测到 CMV DNA，其中 5 例（83%）患者在粪便中检测到 CMV DNA。13 例患者在活检和粪便样本中未检测到 CMV DNA。与基于黏膜活检的 PCR 检测相比，基于 PCR 的粪便检测 CMV DNA 的敏感性、特异性和准确性分别为 83%、93%和 90%。
本研究表明，与黏膜活检相比，该非侵入性检测方法检测粪便样本中 CMV DNA 的准确性较高。这种方法可能为 IBD 患者严重发作时潜在的 CMV 感染提供一种非内镜检测方法，也可更广泛地用于确定 IBD 患者 CMV 感染的流行率。
