摘要
目的探讨重度溃疡性结肠炎(UC)患者感染巨细胞病毒(CMV)的危险因素及抗病毒治疗对疾病的影响。方法回顾分析德阳市人民医院2015年1月-2018年9月收治的重度UC患者160例,均行免疫组化染色检查CMV,基于是否CMV感染分为感染组与未感染组,整理重度UC合并CMV疾病特点、治疗相关资料,以Logistics回归分析重度UC感染CMV的危险因素。统计重度UC合并CMV患者抗病毒治疗情况,分析抗病毒治疗对重度UC临床缓解及复发率的影响。结果 160例重度UC中感染CMV 46例,感染率为28.75%。感染组的白细胞计数、内镜下深大溃疡、纵行溃疡、发热、腹痛、体重下降、并发症率、既往糖皮质激素史、既往免疫抑制剂史均高于未感染组,血红蛋白、高敏C-反应蛋白(hs-CRP)、白蛋白水平低于未感染组,差异均有统计学意义(P<0.05)。既往糖皮质激素史、既往免疫抑制剂史、低白蛋白、低血红蛋白是重度UC患者合并CMV感染的危险因素(P<0.05)。46例重度UC合并CMV感染患者中,29例开展抗病毒治疗,17例未抗病毒治疗,抗病毒治疗患者早期临床缓解率(82.76%)明显高于未抗病毒治疗者(64.71%)(P<0.05);持续随访12个月,抗病毒治疗者院外UC复发率(24.14%)明显低于未抗病毒治疗者(52.94%)(P<0.05)。结论重度UC患者出现体重下降、发热、腹痛症状,内镜下可见深大溃疡、纵行溃疡等特征,需警惕是否感染CMV,糖皮质激素、免疫抑制剂使用、低白蛋白、低血红蛋白是CMV感染发生的危险因素,需加强易感患者监测,及时给予抗病毒治疗,改善预后。
Objective To investigate the risk factors of cytomegalovirus(CMV) infection in patients with severe ulcerative colitis(UC) and the effect of antiviral therapy on the disease.Methods 160 patients with severe UCwere retrospectively analyzed,and the immunohistochemical staining was performed to examine CMV.Patients were divided into CMV infection group and CMV uninfected group.The effect of antiviral therapy on clinical remission and recurrence of severe UC in patients with severe UCand CMV infection.Results Among 160 cases of severe UC,46 cases were infected with CMV,and the infection rate was 28.75%.The white blood cell count,deep ulcer under endoscopy,longitudinal ulcer,fever,abdominal pain,weight loss,complication rate,history of glucocorticoids,and history of immunosuppressive agents in the infected group were higher than those in the uninfected group;hemoglobin,high-sensitivity C-reactive protein(hs-CRP)and albumin were lower than those in the uninfected group,and the differences were statistically significant(P<0.05).Past glucocorticoid history,past immunosuppressive history,low albumin,and low hemoglobin were risk factors for CMV infection in patients with severe UC(P<0.05).Of the 46 patients with severe UCcombined with CMV infection,29 were treated with antiviral therapy and 17 were not treated with antiviral therapy.The early clinical remission rate(82.76%) of patients with antiviral therapy was significantly higher than that without antiviral therapy(64.71%)(P<0.05).After continuous follow-up for 12 months,the out-of-hospital UC recurrence rate(24.14%) of antiviral treatment patients was significantly lower than that of non-antiviral treatment patients(52.94%)(P<0.05).Conclusion Patients with severe UC have symptoms such as weight loss,fever,and abdominal pain.Deep ulcers and longitudinal ulcers can be seen under endoscopy.Glucocorticoids,the use of immunosuppressants,low albumin,and low hemoglobin were risk factors for CMV infection.Monitoring of susceptible patients of CMV infection should be strengthened,and antiviral treatment should be given in time to improve the prognosis.
作者
申洋
胡仁伟
SHEN Yang;HU Ren-wei(Department of Gastroenterology,Deyang People’s Hospital,De.yang,Sichuan 618000;Department of Gastroenterology,West China Hospital,Sichuan University,Chengdu,Sichuan 6100041,China)
出处
《热带医学杂志》
CAS
2020年第6期791-794,798,共5页
Journal of Tropical Medicine
基金
四川省卫生和计划生育委员会科研课题(16PJ139)。
