Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon.
Gastroenterology and Liver Services, Concord Hospital, Sydney, NSW, Australia.
J Crohns Colitis. 2020 Sep 7;14(8):1162-1171. doi: 10.1093/ecco-jcc/jjaa036.
Despite multiple studies, the role of cytomegalovirus [CMV] infection in exacerbating the severity of inflammation in ulcerative colitis [UC], and its response to treatment, remain debatable. Additionally, the optimal diagnostic tests for CMV infection in the setting of UC relapse, and timing of antiviral treatment initiation, remain unclear. The challenge faced by gastroenterologists is to differentiate between an acute UC flare and true CMV colitis. It seems that the presence of CMV colitis, as defined by the presence of intranuclear or intracellular inclusion bodies on haematoxylin and eosin [H&E] staining and/or positive immunohistochemistry [IHC] assay on histology, is associated with more severe colitis. Patients with CMV infection and acute severe colitis are more resistant to treatment with corticosteroids than non-infected patients. This refractoriness to steroids is related to colonic tissue CMV viral load and number of inclusion bodies [high-grade CMV infection] which may have a pronounced effect on clinical outcomes and colectomy rates. Whereas many studies showed no effect for antiviral treatment on colectomy rates in CMV-infected UC patients, there was a significant difference in colectomy rates of patients with high-grade infection who received anti-viral therapy compared with those who did not receive treatment. It was therefore proposed that high-grade CMV disease indicates that the virus is acting as a pathogen, whereas in those with low-grade CMV disease, the severity of IBD itself is more likely to influence outcome. The different algorithms that have been put forward for the management of patients with UC and concomitant CMV infection are discussed.
尽管进行了多项研究，但巨细胞病毒（CMV）感染在加重溃疡性结肠炎（UC）炎症严重程度及其对治疗的反应方面的作用仍存在争议。此外，UC 复发时用于 CMV 感染的最佳诊断测试以及开始抗病毒治疗的时机仍不清楚。胃肠病学家面临的挑战是区分急性 UC 发作和真正的 CMV 结肠炎。似乎 CMV 结肠炎的存在，如苏木精和伊红（H&E）染色存在核内或细胞内包涵体和/或组织学上的免疫组织化学（IHC）检测呈阳性所定义的，与更严重的结肠炎有关。与未感染的患者相比，CMV 感染和急性重度结肠炎患者对皮质类固醇治疗的反应性更差。这种对类固醇的耐药性与结肠组织 CMV 病毒载量和包涵体数量（高级别 CMV 感染）有关，这可能对临床结局和结肠切除术率有明显影响。虽然许多研究表明抗病毒治疗对 CMV 感染的 UC 患者的结肠切除术率没有影响，但接受抗病毒治疗的高级别感染患者与未接受治疗的患者的结肠切除术率有显著差异。因此，提出高级别 CMV 疾病表明病毒是作为病原体起作用，而在低级别 CMV 疾病中，IBD 本身的严重程度更有可能影响结局。讨论了为并发 CMV 感染的 UC 患者提出的不同管理算法。
