Department of Surgery, Queen Margaret Hospital, Dunfermline, United Kingdom.
J Crohns Colitis. 2009 Sep;3(3):141-8. doi: 10.1016/j.crohns.2009.03.002. Epub 2009 Apr 14.
Steroid-resistance presents a management challenge in ulcerative colitis. How steroid-resistance occurs is unknown, but cytomegalovirus infection, often unrecognised, may be the cause in some patients. Current evidence and therapeutic recommendations are examined.
A systematic review of PubMed and EMBASE databases was performed. Search and exclusion criteria are defined in the text.
Heterogeneity of experimental design and definitions of key terms were notable. Criteria for cytomegalovirus disease, infection or detection varied, as did definitions of steroid-resistance. CMV infection defined by antigenaemia or serology was common in patients on steroids and associated with a higher rate of steroid-resistance (41.66-61% versus 0-68% in steroid-responsive patients). Colonic mucosal cytomegalovirus disease detected by histopathology was associated with intravenous steroid-resistance in 5-36%, compared to 0-10% of steroid-responsive patients. CMV colitis has rarely been reported in association with ulcerative colitis without steroids or other immunomodulators. CMV colitis in healthy individuals is so exceptional as to be the topic of case reports.
Ulcerative colitis and its treatment put patients at risk of CMV infection or reactivation. A distinction is necessary between CMV disease (colitis) and CMV infection. Only colonic mucosal CMV infection detected by histopathology appears clinically relevant and appropriate for antiviral therapy. CMV antigenaemia may be associated with steroid-resistance, but may also be a self-limiting marker of viral reactivation. The impact of CMV on steroid-resistance is complicated by inconsistencies in the literature. Coherent definitions of clinically relevant CMV infection and steroid-resistance are needed.
在溃疡性结肠炎中，类固醇耐药性是一个管理难题。目前尚不清楚类固醇耐药性是如何发生的，但未被识别的巨细胞病毒感染可能是某些患者的病因。本文对现有证据和治疗建议进行了考察。
对 PubMed 和 EMBASE 数据库进行了系统性回顾。在正文中定义了检索和排除标准。
实验设计和关键术语的定义存在显著的异质性。巨细胞病毒疾病、感染或检测的标准各不相同，类固醇耐药性的定义也不同。通过抗原血症或血清学定义的 CMV 感染在使用类固醇的患者中很常见，并且与更高的类固醇耐药率相关（41.66-61%与类固醇反应性患者的 0-68%相比）。通过组织病理学检测到的结直肠黏膜巨细胞病毒疾病与静脉内类固醇耐药性相关，而类固醇反应性患者的发生率为 5-36%，0-10%。在没有类固醇或其他免疫调节剂的情况下，溃疡性结肠炎伴 CMV 结肠炎的情况很少见。在健康个体中，CMV 结肠炎非常罕见，以至于成为病例报告的主题。
溃疡性结肠炎及其治疗使患者面临巨细胞病毒感染或再激活的风险。有必要区分 CMV 疾病（结肠炎）和 CMV 感染。只有通过组织病理学检测到的结直肠黏膜 CMV 感染才具有临床相关性，并适合抗病毒治疗。CMV 抗原血症可能与类固醇耐药性相关，但也可能是病毒再激活的自限性标志物。CMV 对类固醇耐药性的影响因文献中的不一致而变得复杂。需要对具有临床相关性的 CMV 感染和类固醇耐药性进行一致的定义。
