Medical Virology Unit, University Hospital, Reims, France.
J Med Virol. 2010 Oct;82(10):1694-700. doi: 10.1002/jmv.21877.
Although numerous reports have described inflammatory bowel diseases (IBDs) complicated with cytomegalovirus (CMV) infection, the virus participation as an exacerbating factor remains unclear. The aim of this study was thus to clarify the clinical significance of CMV infection complicating exacerbation and to correlate CMV detection with various characteristics in IBD patients. Sixty-seven colonic biopsies obtained from 53 patients admitted for IBD exacerbation were retrospectively analyzed by real-time PCR assay. The CMV genome was detected in seven (10.4%) colonic biopsies related to seven patients (three ulcerative colitis and four Crohn's diseases). Among the patients with IBD studied, patients with evidence of CMV infection were older (P = 0.047), were more likely male gender (relative risk [RR] 4.48; 95% confidence interval [CI] 0.94-21.36), received corticosteroids (RR 3.2; CI 0.79-13.02) or azathioprine (RR 3.17; CI 0.80-12.57) treatments, presented more extended lesions (RR for rectum-sigmoid-left colon 3.75 (0.0-69.37) and for pancolitis 2.45 (0.36-16.23)), and had a more severe disease (RR 3.3; CI 0.87-12.48) than those without CMV infection. Viral loads measured in the colonic mucosa of infected patient ranged from 5 to 236961 genome copies by microgram of total extracted DNA. No relationship was observed between the severity of the disease and the viral load level. Furthermore, CMV disappeared in five infected IBD patients in remission without antiviral agents. In conclusion, these results showed infrequent CMV detection in colonic biopsies of IBD patients during exacerbation leaving open the question of the relationship between CMV reactivation and the onset or the severity of IBD exacerbation.
虽然有许多报道描述了炎症性肠病 (IBD) 合并巨细胞病毒 (CMV) 感染，但病毒作为加重因素的参与仍不清楚。因此，本研究旨在阐明 CMV 感染合并加重的临床意义，并将 CMV 检测与 IBD 患者的各种特征相关联。通过实时 PCR 检测，对 53 例因 IBD 加重而住院的患者的 67 份结肠活检进行了回顾性分析。在与 7 名患者（3 名溃疡性结肠炎和 4 名克罗恩病）相关的 7 份结肠活检中检测到 CMV 基因组。在所研究的 IBD 患者中，有 CMV 感染证据的患者年龄较大 (P=0.047)，更可能为男性 (相对风险 [RR] 4.48；95%置信区间 [CI] 0.94-21.36)，接受皮质类固醇 (RR 3.2；CI 0.79-13.02) 或硫唑嘌呤 (RR 3.17；CI 0.80-12.57) 治疗，呈现更广泛的病变 (直肠-乙状结肠-左结肠的 RR 为 3.75 (0.0-69.37)，全结肠炎的 RR 为 2.45 (0.36-16.23))，且疾病更严重 (RR 3.3；CI 0.87-12.48) 比未感染 CMV 的患者。感染患者结肠黏膜中的病毒载量范围为每微克总提取 DNA 5 至 236961 个基因组拷贝。未观察到疾病严重程度与病毒载量水平之间存在相关性。此外，在没有抗病毒药物的情况下，5 例缓解期感染 IBD 的患者 CMV 消失。总之，这些结果表明在 IBD 患者加重期间，在结肠活检中很少检测到 CMV，这使得 CMV 再激活与 IBD 加重的发作或严重程度之间的关系成为一个悬而未决的问题。
