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溃疡性结肠炎合并巨细胞病毒及EB病毒感染患者的临床特点

Clinical features of ulcerative colitis patients complicated with cytomegalovirus and Epstein-Barr virus infections

摘要:

目的 分析溃疡性结肠炎(ulcerative colitis,UC)同时合并巨细胞病毒(cytomegalovirus,CMV)及EB病毒(Epstein-Barr virus,EBV)感染患者的临床特点及治疗转归.方法 将2013年1月1日至2016年12月31日北医三院确诊为UC并进行CMV和EBV感染相关检测的全部住院患者作为研究对象,通过回顾性病例调查采集患者的人口学资料及临床信息,并进行分析.结果 共纳入110例UC患者,其中23例(23/110,20.9%)合并CMV感染,26例(26/110,23.6%)合并EBV感染,13例(13/110,11.8%)同时合并CMV、EBV感染.7例UC同时合并CMV、EBV感染患者的病情程度为重度,12例为广泛结肠型.CMV与EBV共同感染的UC患者腹痛、体重下降多见,血红蛋白、血白蛋白水平较低,而红细胞沉降率、C反应蛋白水平较高;内镜下表现深大溃疡多见,活动分级多为III级.多因素logistic回归分析显示,入院前3个月内应用糖皮质激素是CMV、EBV感染的危险因素.13例UC同时合并CMV、EBV感染的患者中,12例接受了抗病毒药物更昔洛韦治疗,病情均好转.1例未予抗病毒治疗,3天后粪便CMV DNA、EBV DNA均转阴.结论 UC患者可同时伴有CMV、EBV感染,应注意筛查.UC同时合并CMV、EBV感染患者的病情较重.对UC同时合并CMV、EBV感染患者进行抗病毒治疗可能有助于改善病情.

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abstracts:

Objective To analyze the clinical features and treatment outcomes of ulcerative colitis (UC) patients infected with both cytomegalovirus (CMV) and Epstein-Barr virus (EBV). Methods The research subjects were hospitalized patients who were diagnosed as UC and were tested for CMV and EBV in Peking University Third Hospital from January 1, 2013 to December 31, 2016. Demographic information and clinical features were collected retrospectively for the analysis. Results A total of 110 UC patients were enrolled, including 23 patients (20.9%) with CMV infections, 26 patients (23.6%) with EBV infections and 13 patients (11.8%) infected with both CMV and EBV. Of the 13 patients infected with both CMV and EBV, seven cases (53.8%) were in severe clinical conditions. Twelve cases (92.3%) were extensive colitis. Abdominal pain and weight loss were more common in the UC patients infected with both CMV and EBV. The levels of hemoglobin and blood albumin were lower, while the levels of erythrocyte sedimentation rate and C-reactive protein were higher. Large and deep ulcers under endoscopy, with the activity of grade III can usually be observed. Multivariate logistic regression analysis indicated that the treatment with glucocorticoid 3 months before hospitalization was a risk factor of CMV and EBV infections. For the 13 UC patients infected with both CMV and EBV, 12 cases received antiviral therapy of ganciclovir and got improvement after treatment while one case received no antiviral therapy, but the CMV DNA and EBV DNA in stool samples turned negative in 3 days. Conclusions The co-infection of CMV and EBV can occur in UC patients and should be screened. UC patients infected with both CMV and EBV showed more severe conditions. Antiviral therapy may improve clinical conditions of UC patients infected with both CMV and EBV.

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