Al-Zafiri Raed, Gologan Adrian, Galiatsatos Polymnia, Szilagyi Andrew
Dr. Al-Zafiri is a Gastroenterology Fellow, Dr. Galiatsatos is a Physician, and Dr. Szilagyi is a Physician in the Division of Gastroenterology at Sir Mortimer B. Davis Jewish General Hospital and McGill University in Montreal, Quebec. Dr. Gologan is a Pathologist in the Department of Pathology at Sir Mortimer B. Davis Jewish General Hospital and McGill University in Montreal, Quebec.
Gastroenterol Hepatol (N Y). 2012 Apr;8(4):230-9.
There is an ongoing debate regarding the signifcance of cytomegalovirus (CMV) in colonic biopsies and the effect of antiviral therapy in patients with infammatory bowel disease (IBD). In order to evaluate the possible impact of CMV disease on IBD patients, we reviewed charts of patients admitted through the emergency department with diagnoses of IBD and CMV over a 10-year period (January 2000 to November 2009). Laboratory test results and pharmacology databases were scrutinized, and pathology slides were re-evaluated when possible. The control group consisted of a historical group of IBD patients with fares who had been similarly evaluated in the emergency department but who did not have a diagnosis of CMV. Both chi-square tests and the student's t-test were used for analysis. The study consisted of 31 patients with IBD and CMV (median age, 60 years; 65% male; 58% ulcerative colitis patients). Immunohistochemistry confirmed the diagnosis in 19 cases (61%). Nine patients with CMV and IBD underwent a colectomy (29%) compared to 65 of the 581 patients in the control group (11.2%), who were evaluated during the same time period but did not have CMV (P=.007). Mortality was similar in both groups. Of the patients with CMV, 11 received ganciclovir. No significant differences in outcomes were noted with antiviral therapy. Although CMV disease is relatively uncommon in IBD patients, its presence may designate an increased risk for colectomy for reasons that are not yet clear. Patient outcomes may be independently affected by age and comorbidities. Systematic prospective studies could help determine the true effects of CMV on IBD patients.
关于巨细胞病毒（CMV）在结肠活检中的意义以及抗病毒治疗对炎症性肠病（IBD）患者的影响，目前仍存在争议。为了评估CMV疾病对IBD患者的可能影响，我们回顾了在10年期间（2000年1月至2009年11月）通过急诊科收治的诊断为IBD和CMV的患者病历。仔细审查了实验室检查结果和药理学数据库，并在可能的情况下重新评估了病理切片。对照组由一组有发作的IBD患者组成，这些患者在急诊科接受了类似的评估，但未诊断出CMV。采用卡方检验和学生t检验进行分析。该研究包括31例IBD和CMV患者（中位年龄60岁；65%为男性；58%为溃疡性结肠炎患者）。免疫组织化学在19例（61%）中确诊。9例CMV和IBD患者接受了结肠切除术（29%），而同期评估的对照组581例患者中有65例（11.2%）接受了结肠切除术，但这些患者没有CMV（P = 0.007）。两组的死亡率相似。在CMV患者中，11例接受了更昔洛韦治疗。抗病毒治疗在结局方面未发现显著差异。虽然CMV疾病在IBD患者中相对不常见，但其存在可能表明结肠切除术风险增加，原因尚不清楚。患者结局可能独立受到年龄和合并症的影响。系统的前瞻性研究有助于确定CMV对IBD患者的真正影响。
