Department of Internal Medicine, Botucatu Medical School, Botucatu, Brazil.
Clin Transplant. 2012 Mar-Apr;26(2):345-50. doi: 10.1111/j.1399-0012.2011.01514.x. Epub 2011 Oct 21.
The purpose of this article was to report a series of 23 renal transplant recipients with histologically proven and immunohistochemically confirmed cytomegalovirus (CMV) lesions in the gastrointestinal tract (GIT) and to assess the risk factors associated with severe disease/mortality. CMV patients (n=23) were allocated into two groups: those who died (n=6) and those considered cured (n=17). Overall mortality rate was 26% (6/23). Initial symptoms suggestive of lower GIT involvement were observed in all death cases and in 35.3% of those cured (p=0.01). Enterorrhagia was seen in 83.3% of the patients who died. Death risk increased twofold (RR 2 [1.13-3.52], p=0.01) when symptoms of lower GIT involvement were initially observed and sixfold when enterrohagia was present (RR 6 [1.1-35.9], p=0.001). Among death cases, mean time at diagnosis was significantly more distant (2002±2.9×2008±1.6, p=0.04). The difference in mortality rates seen as service practices changed along the years demonstrates the importance of early diagnosis.
本文旨在报告 23 例经组织学和免疫组织化学证实的胃肠道（GI）巨细胞病毒（CMV）病变的肾移植受者，并评估与严重疾病/死亡率相关的危险因素。将 CMV 患者（n=23）分为两组：死亡组（n=6）和治愈组（n=17）。总死亡率为 26%（6/23）。所有死亡病例和 35.3%的治愈病例均出现下胃肠道受累的初始症状（p=0.01）。83.3%的死亡患者出现肠出血。当观察到下胃肠道受累的初始症状时，死亡风险增加两倍（RR 2 [1.13-3.52]，p=0.01），当出现肠出血时，死亡风险增加六倍（RR 6 [1.1-35.9]，p=0.001）。在死亡病例中，诊断时的时间间隔明显更长（2002±2.9×2008±1.6，p=0.04）。随着服务实践多年来的变化，死亡率的差异表明早期诊断的重要性。
