Yin Yu-Ming, Wu Tong, Ji Shu-Quan, Da Wan-Ming, Zhao Yan-Li, Wang Jing-Bo, Cao Xing-Yu, Lu Yue, Sun Yuan, Tong Chun-Rong, Lu Dao-Pei
Beijing Daopei Hospital, Beijing, China.
Zhonghua Xue Ye Xue Za Zhi. 2011 Aug;32(8):516-20.
To analyse the clinical features, diagnostic methods and risk factors of cytomegalovirus (CMV) enteritis after allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Analysis was made on 24 cases of CMV enteritis after allo-HSCT in Beijing Daopei Hospital from Aug. 2007 to Jul. 2009, including clinical data, endoscopic diagnosis, histopathological and virological results, and the association between CMV enteritis with viremia and graft-versus-host disease(GVHD).
87.5% of the patients were over 18 years old. The median time to diagnosis of CMV enteritis was 63 days after HSCT. The mucosal lesions in enteroscopic examination had no significant differences between CMV enteritis and gastrointestinal GVHD complicated with the enteritis. The methods used in diagnosis included histopathology (32.1%) and virology (92.9%). The copies of CMVDNA in mucosal samples greater than 10(5)/10(6) PBNC was better diagnosis. A number of risk factors were compared between the survival and death groups: type of transplant, conditioning regimen, the time span of ganciclovir prophylaxis therapy, grade II-IV GVHD before enteritis, the time of diagnosis as GVHD, using MP > or = 1 mg/kg to treat GVHD, the time between GVHD and enteritis, CMV viremia before enteritis, the time of diagnosis as enteritis, CMVDNA quantitation, and there were no any statistic differences.
Cytomegalovirus enteritis should be carefully diagnosed by histopathology and virology through endoscopic examination. It is better to undertake pan-colon endoscopy as well as terminal ileum examination for more accurate diagnosis. PCR can significantly improve the detection rate. CMVDNA detection in patients' stool may be helpful to diagnosis, especially for those patients who can not stand the endoscopy examination.
分析异基因造血干细胞移植（allo-HSCT）后巨细胞病毒（CMV）肠炎的临床特征、诊断方法及危险因素。
对2007年8月至2009年7月在北京道培医院接受allo-HSCT后发生CMV肠炎的24例患者进行分析，内容包括临床资料、内镜诊断、组织病理学及病毒学结果，以及CMV肠炎与病毒血症和移植物抗宿主病（GVHD）之间的关联。
87.5%的患者年龄超过18岁。诊断CMV肠炎的中位时间为HSCT后63天。CMV肠炎与合并肠炎的胃肠道GVHD在肠镜检查中的黏膜病变无显著差异。诊断方法包括组织病理学（32.1%）和病毒学（92.9%）。黏膜样本中CMVDNA拷贝数大于10(5)/10(6) PBNC时诊断效果更佳。比较了生存组和死亡组之间的一些危险因素：移植类型、预处理方案、更昔洛韦预防性治疗的时间跨度、肠炎前II-IV级GVHD、诊断为GVHD的时间、使用MP≥1 mg/kg治疗GVHD、GVHD与肠炎之间的时间、肠炎前CMV病毒血症、诊断为肠炎的时间、CMVDNA定量，均无统计学差异。
CMV肠炎应通过内镜检查，采用组织病理学和病毒学方法仔细诊断。最好进行全结肠内镜检查以及末段回肠检查以获得更准确的诊断。PCR可显著提高检测率。检测患者粪便中的CMVDNA可能有助于诊断，特别是对于那些无法耐受内镜检查的患者。
