溃疡性结肠炎合并巨细胞病毒感染的诊治进展
Progress in Diagnosis and Treatment of Ulcerative Colitis with Cytomegalovirus Infection
DOI: 10.12677/ACM.2022.1281101, PDF,   
作者: 吴海丽, 孟存英*：延安大学附属医院消化内科，陕西 延安
关键词: 溃疡性结肠炎；巨细胞病毒；诊断；治疗；Ulcerative Colitis； Cytomegalovirus； Diagnosis； Treatment
摘要: 溃疡性结肠炎(ulcerative colitis, UC)是一种病因不明的慢性复发性非特异性炎症性肠病，主要引起结肠黏膜炎症，包括腹泻、便血、腹痛等胃肠道症状。由于通常用皮质类固醇、免疫抑制剂、生物制剂治疗，导致患者的免疫功能受到了一定的抑制作用，进而增加了机会性感染的风险。其中巨细胞病毒(cytomegalovirus, CMV)感染较为常见。因此，CMV感染是UC诱导和维持治疗中的一个棘手问题。故本文就UC合并CMV感染的流行病学、检测手段及治疗策略作一综述。
Abstract: Ulcerative colitis (UC) is a chronic relapsing nonspecific inflammatory disease of unknown etiology, which mainly causes colonic mucosal inflammation and gastrointestinal symptoms such as diarrhea, blood in the stool, and abdominal pain. Due to the usual treatment with corticosteroids, immuno-suppressants, and biological agents, the patient’s immune function is inhibited to a certain extent, thereby increasing the risk of opportunistic infections. Among them, cytomegalovirus (CMV) infec-tion is more common. Therefore, CMV infection is a thorny problem in the induction and mainte-nance therapy of UC. Therefore, this article reviews the epidemiology, detection methods and treatment strategies of UC complicated with CMV infection.
文章引用：吴海丽, 孟存英. 溃疡性结肠炎合并巨细胞病毒感染的诊治进展[J]. 临床医学进展, 2022, 12(8): 7627-7633. https://doi.org/10.12677/ACM.2022.1281101

参考文献

[1] Kwon, J., et al. (2022) Cytomegalovirus-Related Colitis in Patients with Inflammatory Bowel Disease. International Journal of Colorectal Disease, 37, 685-691. [Google Scholar] [CrossRef] [PubMed]
[2] Watanabe, Y., Hayashi, K. and Terai, S. (2022) A Rare Case of Ulcerative Colitis with Severe Pneumocystis jirovecii Pneumonia and Cytomegalovirus Colitis: A Case Report and Literature Review. Internal Medicine, 61, 339-344. [Google Scholar] [CrossRef] [PubMed]
[3] Azer, S.A. and Limaiem, F. (2022) Cytomegalovirus Colitis. StatPearls Publishing, Treasure Island.
[4] Römkens, T.E., et al. (2016) Cytomegalovirus in Inflammatory Bowel Dis-ease: A Systematic Review. World Journal of Gastroenterology, 22, 1321-1330. [Google Scholar] [CrossRef] [PubMed]
[5] Yang, H. and Qian, J.M. (2022) Current Status of Cytomegalovirus Colitis among Patients with Inflammatory Bowel Disease in China: A Questionnaire-Based Multi-Center Study. Inflam-matory Bowel Diseases, 28, S45-S51. [Google Scholar] [CrossRef] [PubMed]
[6] Szymon, O. and Anthony, C. (2022) Viral Enteric Infections in Acute Se-vere Ulcerative Colitis. Journal of Crohn’s and Colitis, jjac028.
[7] Zhang, M., et al. (2022) The Role of Cytomegalo-virus Colitis on Short- and Long-Term Outcomes for Patients with Ulcerative Colitis. Scandinavian Journal of Gastro-enterology, 57, 282-289. [Google Scholar] [CrossRef] [PubMed]
[8] Yang, H., et al. (2017) The Association between CMV Vi-remia or Endoscopic Features and Histopathological Characteristics of CMV Colitis in Patients with Underlying Ulcera-tive Colitis. Inflammatory Bowel Diseases, 23, 814-821. [Google Scholar] [CrossRef] 
[9] Oh, S.J., et al. (2019) True Cytomegalovirus Colitis Is a Poor Prognostic Indicator in Patients with Ulcerative Colitis Flares: The 10-Year Experience of an Academic Referral In-flammatory Bowel Disease Center. Scandinavian Journal of Gastroenterology, 54, 976-983. [Google Scholar] [CrossRef] [PubMed]
[10] Jena, A., et al. (2022) Cytomegalovirus in Ulcerative Colitis: An Evidence-Based Approach to Diagnosis and Treatment. Expert Review of Gastroenterology & Hepatology, 16, 109-120. [Google Scholar] [CrossRef] [PubMed]
[11] Yokoyama, Y., et al. (2020) Current Diagnostic and Therapeutic Approaches to Cytomegalovirus Infections in Ulcerative Colitis Patients Based on Clinical and Basic Research Data. International Journal of Molecular Sciences, 21, Article No. 2438. [Google Scholar] [CrossRef] [PubMed]
[12] Yang, H., et al. (2020) IgA, Albumin, and Eosinopenia as Early Indi-cators of Cytomegalovirus Infection in Patients with Acute Ulcerative Colitis. BMC Gastroenterology, 20, Article No. 294. [Google Scholar] [CrossRef] [PubMed]
[13] Horton, N., et al. (2016) Impact of Low Immunoglobulin G Levels on Disease Outcomes in Patients with Inflammatory Bowel Diseases. Digestive Diseases and Sciences, 61, 3270-3277. [Google Scholar] [CrossRef] [PubMed]
[14] Ciccocioppo, R., et al. (2021) Human Cytomegalovi-rus and Epstein-Barr Virus Specific Immunity in Patients with Ulcerative Colitis. Clinical and Experimental Medicine, 21, 379-388. [Google Scholar] [CrossRef] [PubMed]
[15] Paul, M., et al. (2018) Diagnostic Utility of Quantita-tive Cytomegalovirus DNA Polymerase Chain Reaction in Intestinal Biopsies from Patients with Inflammatory Bowel Disease. Journal of Laboratory Physicians, 10, 38-43. [Google Scholar] [CrossRef] 
[16] Hokama, A. (2018) Correction for “Evaluation of a Multiplex PCR Assay for Detection of Cytomegalovirus in Stool Samples from Patients with Ulcerative Colitis” (World Journal of Gas-troenterology 2015; 21: 12667-12675). World Journal of Gastroenterology, 24, 876. [Google Scholar] [CrossRef] [PubMed]
[17] Ciccocioppo, R., et al. (2015) Human Cytomegalovirus and Ep-stein-Barr Virus Infection in Inflammatory Bowel Disease: Need for Mucosal Viral Load Measurement. World Journal of Gastroenterology, 21, 1915-1926. [Google Scholar] [CrossRef] [PubMed]
[18] Kim, S.H., et al. (2017) Clinical Applications of Interferon-γ Releas-ing Assays for Cytomegalovirus to Differentiate Cytomegalovirus Disease from Bystander Activation: A Pilot Proof-of-Concept Study. The Korean Journal of Internal Medicine, 32, 900-909. [Google Scholar] [CrossRef] [PubMed]
[19] Rahier, J.F., et al. (2014) Second European Evidence-Based Consensus on the Prevention, Diagnosis and Management of Opportunistic Infections in Inflammatory Bowel Disease. Journal of Crohn’s and Colitis, 8, 443-468. [Google Scholar] [CrossRef] [PubMed]
[20] Nguyen, M., et al. (2011) Cytomegalovirus Reactivation in Ul-cerative Colitis Patients. Ulcers, 2011, Article ID: 282507. [Google Scholar] [CrossRef] [PubMed]
[21] Okahara, K., et al. (2017) Colonic Cytomegalovirus Detection by Mucosal PCR and Antiviral Therapy in Ulcerative Colitis. PLOS ONE, 12, e0183951. [Google Scholar] [CrossRef] [PubMed]
[22] Nakase, H. and Herfarth, H. (2016) Cyto-megalovirus Colitis, Cytomegalovirus Hepatitis and Systemic Cytomegalovirus Infection: Common Features and Differ-ences. Inflammatory Intestinal Diseases, 1, 15-23. [Google Scholar] [CrossRef] [PubMed]
[23] Kucharzik, T., et al. (2021) ECCO Guidelines on the Prevention, Diagno-sis, and Management of Infections in Inflammatory Bowel Disease. Journal of Crohn’s and Colitis, 15, 879-913. [Google Scholar] [CrossRef] [PubMed]
[24] 杨红, 等. 炎症性肠病合并机会性感染专家共识意见[J]. 中国实用内科杂志, 2017, 37(4): 303-316.
[25] Rubin, D.T., et al. (2019) ACG Clinical Guideline: Ulcerative Colitis in Adults. The American Journal of Gastroenterology, 114, 384-413. [Google Scholar] [CrossRef] [PubMed]
[26] Qin, Y., et al. (2021) Risk Factors of Cytomegalovirus Reac-tivation in Ulcerative Colitis Patients: A Meta-Analysis. Diagnostics (Basel), 11, Article No. 1952. [Google Scholar] [CrossRef] [PubMed]
[27] Yerushalmy-Feler, A., Padlipsky, J. and Cohen, S. (2019) Di-agnosis and Management of CMV Colitis. Current Infectious Disease Reports, 21, Article No. 5. [Google Scholar] [CrossRef] [PubMed]
[28] Pillet, S., Pozzetto, B. and Roblin, X. (2016) Cytomegalovirus and Ulcerative Colitis: Place of Antiviral Therapy. World Journal of Gastroenterology, 22, 2030-2045. [Google Scholar] [CrossRef] [PubMed]
[29] Oh, S.J., et al. (2021) Long-Term Outcomes of Infliximab in a Re-al-World Multicenter Cohort of Patients with Acute Severe Ulcerative Colitis. Intestinal Research, 19, 323-331. [Google Scholar] [CrossRef] [PubMed]
[30] Hommel, C., Pillet, S. and Rahier, J.F. (2020) Comment on: “Resolution of CMV Infection in the Bowel on Vedolizumab Therapy”. Journal of Crohn’s and Colitis, 14, 148-149. [Google Scholar] [CrossRef] [PubMed]
[31] Rawa-Gołębiewska, A., Lenarcik, M. and Zagórowicz, E. (2019) Res-olution of CMV Infection in the Bowel on Vedolizumab Therapy. Journal of Crohn’s and Colitis, 13, 1234-1235. [Google Scholar] [CrossRef] [PubMed]
[32] Karolewska-Bochenek, K., et al. (2021) Faecal Microbiota Transfer—A New Concept for Treating Cytomegalovirus Colitis in Children with Ulcerative Colitis. Annals of Agricultural and Envi-ronmental Medicine, 28, 56-60. [Google Scholar] [CrossRef] [PubMed]
[33] Fukuchi, T., et al. (2013) Effect of Intensive Granulocyte and Monocyte Adsorptive Apheresis in Patients with Ulcerative Colitis Positive for Cytomegalovirus. Journal of Crohn’s and Colitis, 7, 803-811. [Google Scholar] [CrossRef] [PubMed]

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