| 摘要: |
| ［摘要］ 目的 分析溃疡性结肠炎（UC）合并巨细胞病毒（CMV）感染的临床特点及影响因素。方法 回顾性分析2018年1月至2024年6月宁夏医科大学总医院消化内科收治的228例UC患者的临床资料。根据CMV感染情况将其分为CMV阳性组（22例）和CMV阴性组（206例）。比较两组一般资料、实验室指标、内镜表现以及治疗方案和效果。通过多因素logistic回归分析探讨UC合并CMV感染的影响因素。结果 CMV阳性组发热、近1个月使用激素、近1个月使用抗生素，以及黏膜形态学特征为深凿样溃疡、不规则溃疡的人数比例显著高于CMV阴性组（P<0.05）；CMV阳性组正常黏膜的人数比例显著低于CMV阴性组（P<0.05），两组疾病严重程度、Mayo内镜评分分布差异有统计学意义（P<0.05）。CMV阳性组Hb、ALB水平低于CMV阴性组，中性粒细胞与淋巴细胞比值（NLR）、血沉（ESR）、C反应蛋白（CRP）水平高于CMV阴性组，差异有统计学意义（P<0.05）。两组使用生物制剂、免疫抑制剂及接受手术治疗的人数比例差异无统计学意义（P>0.05）。与CMV阴性组相比，CMV阳性组使用糖皮质激素的人数比例更高，糖皮质激素治疗有效的人数比例更低，差异有统计学意义（P<0.05）。多因素logistic回归分析结果显示，深凿样溃疡是UC并发CMV感染的独立危险因素［OR（95%CI）=35.513（3.932～320.759），P=0.001］，较高的Hb水平是抑制UC并发CMV感染的独立保护因素［OR（95%CI）=0.951（0.912～0.991），P=0.016］。结论 重度UC患者易合并CMV感染，Hb水平及内镜下深凿样溃疡与CMV感染具有显著关联，临床医师需加强此类患者的监测，及时给予抗病毒治疗，改善预后。 |
| 关键词: 溃疡性结肠炎 巨细胞病毒 治疗 糖皮质激素 影响因素 |
| DOI：10.3969/j.issn.1674-3806.2025.07.08 |
| 分类号:R 574.1 |
| 基金项目:国家重点研发计划课题（编号：2022YFC3602101）；宁夏自然科学基金项目（编号：2022AAC03570） |
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| Analysis on clinical features and influencing factors of ulcerative colitis complicated with cytomegalovirus infection |
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LIU Jiaxin1,2, ZHANG Li′na1, ZHAO Guihong1,2, SU Rong1, YANG Jiali1, WANG Fang1, YANG Shaoqi1
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1.Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan 750000, China; 2.First School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, China
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| Abstract: |
| ［Abstract］ Objective To analyze the clinical features and influencing factors of ulcerative colitis(UC) complicated with cytomegalovirus(CMV) infection. Methods The clinical data of 228 patients with UC who were admitted to Department of Gastroenterology, General Hospital of Ningxia Medical University from January 2018 to June 2024 were retrospectively analyzed. The patients were divided into CMV-positive group(22 patients) and CMV-negative group(206 patients) according to their CMV infection results. The general data, laboratory indicators, endoscopic manifestations, treatment plans and effects were compared between the two groups. The influencing factors of UC complicated with CMV infection were explored through multivariate logistic regression analysis. Results The proportions of the patients with fever, receiving hormone therapy in the past 1 month, receiving antibiotic therapy in the past 1 month as well as with deep chisel-like ulcer and irregular ulcer as the morphological characteristics of mucosa in the CMV-positive group were significantly higher than those in the CMV-negative group(P<0.05). The proportion of the patients with normal mucosa in the CMV-positive group was significantly lower than that in the CMV-negative group(P<0.05). There were significant differences in disease severity and Mayo endoscopic score distribution between the two groups(P<0.05). The levels of hemoglobin(Hb) and albumin(ALB) in the CMV-positive group were lower than those in the CMV-negative group, and the levels of neutrophil-to-lymphocyte ratio(NLR), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) in the CMV-positive group were higher than those in the CMV-negative group, with statistically significant differences between the two groups(P<0.05). There were no significant differences in the proportions of the patients receiving treatments of biological agents, immunosuppressants and surgery between the two groups(P>0.05). Compared with those in the CMV-negative group, the proportion of the patients receiving treatments of glucocorticoids in the CMV-positive group was higher, and the proportion of the patients responding effectively to the glucocorticoid treatment in the CMV-positive group was lower, with statistically significant differences between the two groups(P<0.05). The results of multivariate logistic regression analysis showed that deep chisel-like ulcer was an independent risk factor for UC complicated with CMV infection［OR(95%CI)=35.513(3.932-320.759), P=0.001］, and higher Hb level was an independent protective factor for inhibiting UC complicated with CMV infection［OR(95%CI)=0.951(0.912-0.991), P=0.016］. Conclusion Patients with severe UC are susceptible to complication with CMV infection. Hb level and deep chisel-like ulcer observed under endoscope are significantly associated with CMV infection. Clinicians need to strengthen the monitoring of such patients and give antiviral therapy promptly to improve the prognosis. |
| Key words: Ulcerative colitis(UC) Cytomegalovirus(CMV) Treatment Glucocorticoids Risk factors |
