Campos Sara T, Portela Francisco A, Tomé Luís
Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Praçeta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.
Int J Colorectal Dis. 2017 May;32(5):645-650. doi: 10.1007/s00384-017-2752-5. Epub 2017 Jan 13.
Anti-TNFα agents emerged in inflammatory bowel disease (IBD) as an effective option in situations that, otherwise, would be refractory to medical therapy. Cytomegalovirus infection may present with a high spectrum of manifestations and lead to high morbidity and mortality. However, its clinical significance in IBD course remains unknown and data on its association with anti-TNFα are limited.
This study aims to evaluate cytomegalovirus (CMV) infection/disease in patients with IBD treated with anti-TNFα; if possible, possible risk factors associated with CMV infection/disease in IBD patients under anti-TNFα as well as the influence of CMV infection/disease in IBD course would be determined.
During three consecutive years, all IBD patients starting infliximab in our department were included. Cytomegalovirus status before anti-TNFα was evaluated. Data regarding IBD, therapeutic and IBD course after infliximab, were recorded. CMV analysis was performed with polymerase chain reaction (PCR)-cytomegalovirus in peripheral blood and colonoscopy with biopsies (histopathology/immunohistochemistry).
We included 29 patients: female-83%; Crohn's disease-51.8%, ulcerative colitis-44.8%, non-classified colitis-3.4%; 23 cytomegalovirus seropositive. Median follow-up: 19 months (3-36). During follow-up, 14 patients were under combination therapy with azathioprine and 5 did at least 1 cycle of corticosteroids. Twenty-one patients responded to infliximab. We registered 8 exacerbations of IBD. Four patients discontinued infliximab: none had CMV infection. We documented 1 case of intestinal cytomegalovirus infection-detected in biopsies performed per protocol in an asymptomatic UC patient, who responded to valganciclovir without infliximab discontinuation.
Infliximab, with/without immunosuppression, does not confer an increased risk of (re)activation of cytomegalovirus. Cytomegalovirus was not responsible neither for significant morbidity nor mortality in IBD.
抗TNFα药物在炎症性肠病（IBD）治疗中成为一种有效的选择，用于那些对药物治疗原本难治的情况。巨细胞病毒感染可能有多种表现，导致高发病率和死亡率。然而，其在IBD病程中的临床意义仍不明确，且其与抗TNFα相关性的数据有限。
本研究旨在评估接受抗TNFα治疗的IBD患者中的巨细胞病毒（CMV）感染/疾病情况；若可能，确定接受抗TNFα治疗的IBD患者中与CMV感染/疾病相关的可能危险因素，以及CMV感染/疾病对IBD病程的影响。
连续三年纳入我科所有开始使用英夫利昔单抗治疗的IBD患者。评估抗TNFα治疗前的巨细胞病毒状态。记录有关IBD、英夫利昔单抗治疗后情况及IBD病程的数据。采用外周血聚合酶链反应（PCR）检测巨细胞病毒及结肠镜检查并活检（组织病理学/免疫组织化学）进行CMV分析。
共纳入29例患者：女性占83%；克罗恩病占51.8%，溃疡性结肠炎占44.8%，未分类结肠炎占3.4%；23例巨细胞病毒血清学阳性。中位随访时间：19个月（3 - 36个月）。随访期间，14例患者接受硫唑嘌呤联合治疗，5例患者至少接受1个周期的皮质类固醇治疗。21例患者对英夫利昔单抗有反应。记录到8例IBD病情加重。4例患者停用英夫利昔单抗：均无CMV感染。记录到1例肠道巨细胞病毒感染，在一名无症状溃疡性结肠炎患者按方案进行的活检中检测到，该患者对缬更昔洛韦有反应，未停用英夫利昔单抗。
英夫利昔单抗无论是否联合免疫抑制治疗，均不会增加巨细胞病毒（再）激活的风险。巨细胞病毒在IBD中既不导致显著的发病率也不导致死亡率。
