Yeh Pai-Jui, Wu Ren-Chin, Chen Chien-Ming, Chiu Cheng-Tang, Lai Ming-Wei, Chen Chien-Chang, Kuo Chia-Jung, Hsu Jun-Te, Su Ming-Yao, Le Puo-Hsien
Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan.
Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan.
J Clin Med. 2022 Mar 13;11(6):1583. doi: 10.3390/jcm11061583.
Cytomegalovirus (CMV) esophagitis is the second most common CMV disease of the gastrointestinal tract. This study aims to comprehensively analyze risk factors, clinical characteristics, endoscopic features, outcomes, and prognostic factors of CMV esophagitis. We retrospectively collected data of patients who underwent esophageal CMV immunohistochemistry (IHC) staining between January 2003 and April 2021 from the pathology database at the Chang Gung Memorial Hospital. Patients were divided into the CMV and non-CMV groups according to the IHC staining results. We enrolled 148 patients (44 CMV and 104 non-CMV patients). The risk factors for CMV esophagitis were male sex, immunocompromised status, and critical illness. The major clinical presentations of CMV esophagitis included epigastric pain (40.9%), fever (36.4%), odynophagia (31.8%), dysphagia (29.5%), and gastrointestinal bleeding (29.5%). Multiple diffuse variable esophageal ulcers were the most common endoscopic feature. The CMV group had a significantly higher in-hospital mortality rate (18.2% vs. 0%; p < 0.001), higher overall mortality rate (52.3% vs. 14.4%; p < 0.001), and longer admission duration (median, 24 days (interquartile range (IQR), 11−47 days) vs. 14 days (IQR, 7−24 days); p = 0.015) than the non-CMV group. Acute kidney injury (odds ratio (OR), 174.15; 95% confidence interval (CI), 1.27−23,836.21; p = 0.040) and intensive care unit admission (OR, 26.53; 95% CI 1.06−665.08; p = 0.046) were predictors of in-hospital mortality. In conclusion, the mortality rate of patients with CMV esophagitis was high. Physicians should be aware of the clinical and endoscopic characteristics of CMV esophagitis in high-risk patients for early diagnosis and treatment.
巨细胞病毒（CMV）食管炎是胃肠道第二常见的CMV疾病。本研究旨在全面分析CMV食管炎的危险因素、临床特征、内镜特征、结局及预后因素。我们回顾性收集了2003年1月至2021年4月在长庚纪念医院病理数据库中接受食管CMV免疫组织化学（IHC）染色的患者数据。根据IHC染色结果将患者分为CMV组和非CMV组。我们纳入了148例患者（44例CMV患者和104例非CMV患者）。CMV食管炎的危险因素为男性、免疫功能低下状态和危重病。CMV食管炎的主要临床表现包括上腹部疼痛（40.9%）、发热（36.4%）、吞咽痛（31.8%）、吞咽困难（29.5%）和胃肠道出血（29.5%）。多发性弥漫性可变食管溃疡是最常见的内镜特征。CMV组的住院死亡率显著高于非CMV组（18.2%对0%；p<0.001），总体死亡率更高（52.3%对14.4%；p<0.001），住院时间更长（中位数，24天（四分位间距（IQR），11 - 47天）对14天（IQR，7 - 24天）；p = 0.015）。急性肾损伤（比值比（OR），174.15；95%置信区间（CI），1.27 - 23836.21；p = 0.040）和入住重症监护病房（OR，26.53；95%CI 1.06 - 665.08；p = 0.046）是住院死亡率的预测因素。总之，CMV食管炎患者的死亡率很高。医生应了解高危患者CMV食管炎的临床和内镜特征以便早期诊断和治疗。
