Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Department of Pathology, Mayo Clinic, Rochester, Minnesota.
Clin Gastroenterol Hepatol. 2015 Jan;13(1):131-7; quiz e7. doi: 10.1016/j.cgh.2014.05.026. Epub 2014 Jun 30.
BACKGROUND & AIMS: The presentation of cytomegalovirus (CMV) disease in patients with inflammatory bowel disease (IBD) can be similar to that of idiopathic IBD. It is a challenge to identify patients at highest risk for CMV. We investigated risk factors and generated a clinical score to identify patients with IBD at highest risk for CMV disease.
We performed a retrospective case-control study of 68 patients with IBD (66% with ulcerative colitis, 31% with Crohn's disease, and 3% with unclassified IBD) diagnosed with CMV disease on the basis of tissue analysis from January 2005 through December 2011 at Mayo Clinic, Rochester. The patients were each matched with 3 patients with IBD and suspected CMV disease (controls). An a priori set of the most objective variables was used to create a model to identify those with CMV disease. Scores were assigned to each significant factor from the multivariable analysis. Cutoff values that identified patients with CMV with ≥85% sensitivity and specificity were selected.
Patients with medically refractory IBD (odds ratio [OR], 3.69; P < .001) or endoscopic ulcers (OR, 3.06; P < .001) and those treated with corticosteroids (OR, 2.95; P < .001) or immunomodulators (OR, 1.86; P = .030) but not tumor necrosis factor antagonists (OR, 1.30; P = .376) were more likely to have CMV disease than patients with IBD without these features. In a multivariable model, refractory disease, treatment with immunomodulators, and age older than 30 years were independently associated with CMV disease. Use of tumor necrosis factor antagonists was an insignificant factor even after adjustment.
Clinical features can identify patients with IBD at risk for CMV disease. This model may help clinicians stratify patients on the basis of risk when CMV disease is suspected.
巨细胞病毒（CMV）疾病在炎症性肠病（IBD）患者中的表现可能与特发性 IBD 相似。识别具有最高 CMV 风险的患者具有挑战性。我们研究了风险因素，并生成了一种临床评分，以识别具有最高 CMV 疾病风险的 IBD 患者。
我们对 2005 年 1 月至 2011 年 12 月在罗切斯特梅奥诊所接受组织分析诊断为 CMV 疾病的 68 例 IBD 患者（66%为溃疡性结肠炎，31%为克罗恩病，3%为未分类 IBD）进行了回顾性病例对照研究。每位患者均与 3 例疑似 CMV 疾病的 IBD 患者（对照组）相匹配。使用一组预先设定的最客观变量来创建一个模型，以识别那些患有 CMV 疾病的患者。从多变量分析中为每个重要因素分配分数。选择能够以≥85%的敏感性和特异性识别 CMV 患者的截断值。
患有医学难治性 IBD（比值比[OR]，3.69；P<0.001）或内镜下溃疡（OR，3.06；P<0.001）以及接受皮质类固醇（OR，2.95；P<0.001）或免疫调节剂（OR，1.86；P=0.030）但未接受肿瘤坏死因子拮抗剂（OR，1.30；P=0.376）治疗的患者比没有这些特征的 IBD 患者更有可能患有 CMV 疾病。在多变量模型中，难治性疾病、免疫调节剂治疗和年龄大于 30 岁与 CMV 疾病独立相关。即使在调整后，使用肿瘤坏死因子拮抗剂也是一个不重要的因素。
临床特征可以识别具有 CMV 疾病风险的 IBD 患者。该模型可帮助临床医生在怀疑 CMV 疾病时根据风险对患者进行分层。
