Section of Pediatric Gastroenterology, Department of Pediatrics and Child Health.
Department of Pathology.
J Pediatr Gastroenterol Nutr. 2018 Aug;67(2):221-224. doi: 10.1097/MPG.0000000000001976.
Although it has been recommended to perform sigmoidoscopy to screen for cytomegalovirus (CMV) reactivation in acute severe colitis, the frequency of CMV reactivation in children with inflammatory bowel disease (IBD) is unknown. The aim of this study was to determine the frequency and management of CMV detection in colonic mucosa of children with IBD.
In a retrospective study, consecutive IBD patients, <17 years old, with moderate to severe colitis who had sigmoid biopsy specimens evaluated for CMV by hematoxylin and eosin (H&E) staining, immunohistochemistry (IHC), and polymerase chain reaction (PCR) were included.
A total of 90 sigmoid biopsies were collected from 67 patient encounters from 58 patients with colitis: 61 patient encounters (91%) with UC/IBD-U including biopsy samples from colectomy specimens of eight patients who had colectomy during the study period. Medication exposure included corticosteroids for 40 (69%) patients, and immunosuppressive agents for 31 (53.4%) patients. Four of 61 patient encounters (6.6%) with UC/IBD-U, two with corticosteroid refractory disease, had positive biopsies for CMV by PCR but negative H&E and IHC. They responded to escalated medical therapy, without needing anti-viral therapy, and none required colectomy over a median duration of follow up of 1.1 year (IQR 1-1.6).
CMV presence is uncommon in colonic mucosa of children with IBD. Studies examining the underlying sero-prevalence of CMV and its role of reactivation of colitis are required to determine if the current recommendation for routine sigmoidoscopy to exclude CMV infection in corticosteroid-refractory acute severe colitis is justified.
虽然已经建议对急性重度结肠炎患者进行乙状结肠镜检查以筛查巨细胞病毒（CMV）再激活，但儿童炎症性肠病（IBD）患者 CMV 再激活的频率尚不清楚。本研究旨在确定 IBD 儿童结肠黏膜中 CMV 检测的频率和管理方法。
在一项回顾性研究中，纳入了接受中度至重度结肠炎治疗且行乙状结肠镜活检的连续 IBD 患者，这些患者的乙状结肠镜活检标本通过苏木精和伊红（H&E）染色、免疫组织化学（IHC）和聚合酶链反应（PCR）进行 CMV 检测。
从 58 例结肠炎患者的 67 次就诊中收集了 90 份乙状结肠镜活检标本：61 次就诊（91%）为 UC/IBD-U，包括 8 例在此期间接受结肠切除术患者的结肠切除标本中的活检样本。药物暴露包括 40 例（69%）患者接受皮质类固醇治疗，31 例（53.4%）患者接受免疫抑制剂治疗。4 例（6.6%）UC/IBD-U 患者，2 例为皮质类固醇难治性疾病，PCR 检测到 CMV 阳性活检，但 H&E 和 IHC 检测为阴性。他们对强化药物治疗有反应，无需抗病毒治疗，在中位数为 1.1 年（IQR 1-1.6）的随访期间，没有患者需要结肠切除术。
CMV 在 IBD 儿童的结肠黏膜中并不常见。需要研究 CMV 的潜在血清流行率及其在皮质类固醇难治性急性重度结肠炎中引发结肠炎的作用，以确定目前建议对皮质类固醇难治性急性重度结肠炎患者进行常规乙状结肠镜检查以排除 CMV 感染是否合理。
