Zidar Nina, Ferkolj Ivan, Tepeš Katja, Štabuc Borut, Kojc Nika, Uršič Tina, Petrovec Miroslav
Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia,
Virchows Arch. 2015 May;466(5):533-9. doi: 10.1007/s00428-015-1741-8. Epub 2015 Feb 21.
Cytomegalovirus (CMV) reactivation is a common complication in patients with inflammatory bowel diseases (IBD), particularly in those with steroid-resistant ulcerative colitis. It is usually diagnosed by histopathologic and immunohistochemical examination of the colon biopsy. The introduction of quantitative, real-time polymerase chain reaction (qPCR) has been recommended to improve the sensitivity, but there is little consensus on how to use it. We compared the two methods in samples from resected bowel of patients with IBD. Twelve patients with IBD who had undergone bowel resection were analysed for CMV, using qPCR and immunohistochemistry. In all cases, tissue samples from the base and the edge of ulcers and from uninvolved mucosa were obtained. The highest densities of CMV-positive cells were found in samples from the base of ulcers (immunohistochemistry 0-0.47 positive cells/mm(2); qPCR 10-3809 viral copies/mg) or the edge of ulcers (immunohistochemistry 0.06-0.32 positive cells/mm(2); qPCR 35-1049 viral copies/mg). In samples of uninvolved mucosa, immunohistochemistry was negative, whereas qPCR was either negative or showed very low values (0-3 viral copies/mg). We conclude that both immunohistochemistry and qPCR can be successfully used for diagnosing CMV reactivation in patients with IBD. The base and the edge of ulcers are the optimal sites for endoscopic biopsies. The density of CMV-positive cells was low and their distribution within the colon uneven. It therefore seems that the number of sampled biopsies and/or the number of investigated levels is more important that the choice of diagnostic method.
巨细胞病毒（CMV）再激活是炎症性肠病（IBD）患者常见的并发症，尤其是在那些对类固醇耐药的溃疡性结肠炎患者中。通常通过结肠活检的组织病理学和免疫组织化学检查来诊断。推荐采用定量实时聚合酶链反应（qPCR）以提高诊断的敏感性，但对于如何使用该方法尚无共识。我们比较了IBD患者切除肠段样本中的两种诊断方法。对12例接受肠切除的IBD患者，采用qPCR和免疫组织化学方法分析CMV情况。所有病例均获取溃疡底部、边缘以及未受累黏膜的组织样本。CMV阳性细胞密度最高的样本来自溃疡底部（免疫组织化学0 - 0.47个阳性细胞/mm²；qPCR 10 - 3809个病毒拷贝/mg）或溃疡边缘（免疫组织化学0.06 - 0.32个阳性细胞/mm²；qPCR 35 - 1049个病毒拷贝/mg）。在未受累黏膜样本中，免疫组织化学呈阴性，而qPCR要么呈阴性，要么显示极低的值（0 - 3个病毒拷贝/mg）。我们得出结论，免疫组织化学和qPCR均可成功用于诊断IBD患者的CMV再激活。溃疡底部和边缘是内镜活检的最佳部位。CMV阳性细胞密度较低且在结肠内分布不均。因此，似乎活检采样数量和/或检测层面数量比诊断方法的选择更为重要。
