充分的抗病毒治疗可降低炎症性肠病住院患者巨细胞病毒结肠炎的总体并发症。

Adequate antiviral treatment lowers overall complications of cytomegalovirus colitis among inpatients with inflammatory bowel diseases.

作者信息

Hsieh Ching-Reigh, Wu Ren-Chin, Kuo Chia-Jung, Yeh Pai-Jui, Yeh Yuan-Ming, Chen Chyi-Liang, Chiu Cheng-Tang, Chiu Cheng-Hsun, Pan Yu-Bin, Tsou Yung-Kuan, Le Puo-Hsien

机构信息

Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.

Department of Anatomic Pathology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.

出版信息

BMC Infect Dis. 2024 Apr 26;24(1):443. doi: 10.1186/s12879-024-09317-w.

DOI:10.1186/s12879-024-09317-w

PMID:38671346

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11046852/

Abstract

BACKGROUND

Cytomegalovirus (CMV) colitis significantly complicates the course of inflammatory bowel disease (IBD), frequently leading to severe flare-ups and poor outcomes. The role of antiviral therapy in hospitalized IBD patients with CMV colitis is currently under debate. This retrospective analysis seeks to clarify the influence of antiviral treatment on these patients.

METHODS

We retrospectively reviewed IBD patients diagnosed with CMV colitis via immunohistochemistry staining from colonic biopsies at a major tertiary center from January 2000 to May 2021. The study focused on patient demographics, clinical features, risk factors, prognostic indicators, and antiviral treatment outcomes.

RESULTS

Among 118 inpatients, 42 had CMV colitis. Risk factors included hypoalbuminemia and antibiotic use. IBD patients with CMV colitis receiving < 14 days of antiviral therapy had higher complication (72% vs. 43%, p = 0.028) and surgery rates (56% vs. 26%, p = 0.017) compared to those without CMV. Adequate antiviral therapy (≥ 14 days) significantly reduced complications in the CMV group (29% vs. 72%, p = 0.006), especially in Crohn's disease (20% vs. 100%, p = 0.015). Independent predictors of IBD-related complications were CMV colitis (Odds Ratio [OR] 3.532, 90% Confidence Interval [CI] 1.012-12.331, p = 0.048), biological treatment failure (OR 4.953, 95% CI 1.91-12.842, p = 0.001), and adequate antiviral therapy (OR 0.108, 95% CI 0.023-0.512, p = 0.005).

CONCLUSION

CMV colitis and a history of biological treatment failure increase complication risks in IBD patients. Adequate antiviral therapy significantly mitigates these risks, highlighting its importance in managing IBD patients with CMV colitis.

摘要

背景

巨细胞病毒（CMV）结肠炎显著使炎症性肠病（IBD）的病程复杂化，常导致严重发作和不良预后。抗病毒治疗在住院的CMV结肠炎IBD患者中的作用目前存在争议。这项回顾性分析旨在阐明抗病毒治疗对这些患者的影响。

方法

我们回顾性分析了2000年1月至2021年5月在一家大型三级中心通过结肠活检免疫组化染色诊断为CMV结肠炎的IBD患者。该研究关注患者的人口统计学特征、临床特征、危险因素、预后指标和抗病毒治疗结果。

结果

在118名住院患者中，42名患有CMV结肠炎。危险因素包括低白蛋白血症和使用抗生素。与未患CMV的IBD患者相比，接受抗病毒治疗少于14天的CMV结肠炎IBD患者并发症发生率（72%对43%，p = 0.028）和手术率（56%对26%，p = 0.017）更高。充分的抗病毒治疗（≥14天）显著降低了CMV组的并发症发生率（29%对72%，p = 0.006），尤其是在克罗恩病患者中（20%对100%，p = 0.015）。IBD相关并发症的独立预测因素是CMV结肠炎（比值比[OR] 3.532，90%置信区间[CI] 1.012 - 12.331，p = 0.048）、生物治疗失败（OR 4.953，95% CI 1.91 - 12.842，p = 0.001）和充分的抗病毒治疗（OR 0.108，95% CI 0.023 - 0.512，p = 0.005）。