Culpepper-Morgan J A, Kotler D P, Scholes J V, Tierney A R
Department of Medicine, St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York.
Am J Gastroenterol. 1987 Dec;82(12):1264-70.
Mucosal cytomegalic inclusion disease (CID) is a serious complication in acquired immune deficiency syndrome (AIDS) that usually is associated with disseminated cytomegalovirus (CMV) infection, and leads progressively to death in many patients. Early diagnosis may improve the chances of responding to specific antiviral therapy. We analyzed retrospectively the diagnostic evaluations of 26 AIDS patients with histopathologically confirmed CID infections and 19 AIDS or AIDS-related complex patients without CMV infections. The groups were similar demographically and clinically. Characteristic CMV inclusion bodies were found on antemortem biopsy in 92% of patients, including 80% for rectal biopsy alone. The specificity of the viral inclusions for CMV was established using an immunohistological technique. Rectal culture for virus isolation was much less sensitive (30%) than biopsy. Urine cultures were positive more frequently (39%) than were rectal cultures, but were less specific. Furthermore, the presence of immunoglobulin G anti-CMV was nonspecific and the presence of immunoglobulin anti-CMV was both insensitive and nonspecific. We conclude that mucosal biopsy is a rapid and reliable means of detecting cytomegalovirus infections, and is an indispensible part of the evaluation for this disease.
黏膜巨细胞包涵体病（CID）是获得性免疫缺陷综合征（AIDS）的一种严重并发症，通常与播散性巨细胞病毒（CMV）感染相关，许多患者会逐渐死亡。早期诊断可能会增加对特定抗病毒治疗产生反应的机会。我们回顾性分析了26例经组织病理学确诊为CID感染的AIDS患者以及19例无CMV感染的AIDS或AIDS相关综合征患者的诊断评估情况。两组在人口统计学和临床特征上相似。92%的患者在生前活检中发现了特征性的CMV包涵体，其中仅直肠活检发现的占80%。采用免疫组织学技术确定了病毒包涵体对CMV的特异性。用于病毒分离的直肠培养敏感性远低于活检（30%）。尿培养阳性率（39%）高于直肠培养，但特异性较低。此外，抗CMV免疫球蛋白G的存在是非特异性的，抗CMV免疫球蛋白的存在既不敏感也无特异性。我们得出结论，黏膜活检是检测巨细胞病毒感染的一种快速可靠的方法，是该疾病评估中不可或缺的一部分。
