Giezendanner S, Wirth H P, Zala G, Weber R, Flury R, Meyenberger C
Abteilung für Gastroenterologie, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1995 Dec 16;125(50):2417-22.
The clinical findings and course in 10 HIV-positive patients with cytomegalovirus (CMV) colitis were analyzed. Homosexuality was the main risk factor for HIV infection. All patients had markedly reduced CD4 counts (mean 25 x 10(9)/l). Symptoms at presentation were chronic diarrhea, weight loss, fever and abdominal pain. One of the patients had an abdominal mass in the ileocecal region due to inflammation as the leading symptom. Endoscopically the colitis was more often segmental than diffuse. In 2 out of 9 patients who underwent colonoscopy, only the right hemicolon was affected. Concurrent intestinal infections with up to 4 different pathogens were found in 7 patients. 5 patients had chorioretinitis as an extraintestinal CMV symptom (2 before, 3 after the occurrence of CMV-colitis). In only one patient was there a partial response of CMV-colitis to therapy with ganciclovir and foscarnet. Even under therapy CMV colitis was complicated in 2 patients by perforation and inflammatory stenosis respectively. Both needed surgical treatment. Most of the patients died of generalized CMV infection or wasting syndrome.
分析了10例人类免疫缺陷病毒（HIV）阳性且患有巨细胞病毒（CMV）结肠炎患者的临床症状及病程。同性恋是HIV感染的主要危险因素。所有患者的CD4计数均显著降低（平均为25×10⁹/L）。就诊时的症状包括慢性腹泻、体重减轻、发热和腹痛。其中1例患者以回盲部炎症性腹部肿块为主要症状。内镜检查显示，结肠炎多为节段性而非弥漫性。在接受结肠镜检查的9例患者中，有2例仅右半结肠受累。7例患者同时感染了多达4种不同病原体。5例患者出现脉络膜视网膜炎这一肠外CMV症状（2例在CMV结肠炎发生前出现，3例在CMV结肠炎发生后出现）。仅1例患者的CMV结肠炎对更昔洛韦和膦甲酸钠治疗有部分反应。即使在治疗过程中，仍有2例患者分别出现CMV结肠炎穿孔和炎性狭窄并发症。两者均需手术治疗。大多数患者死于全身性CMV感染或消耗综合征。
