炎症性肠病患者巨细胞病毒感染危险因素

目的探讨炎症性肠病(IBD)患者巨细胞病毒(CMV)感染危险因素及CMV包膜糖蛋白H(gH)基因分型与临床疗效的关系。方法选取2015年2月-2019年12月河北北方学院附属第一医院收治的IBD患者362例,调查CMV感染情况以及临床疗效,多因素Logistic回归分析IBD患者合并CMV感染的危险因素,分析感染不同CMV gH基因型IBD患者临床特点及临床治疗效果。结果362例IBD患者中CMV感染患者122例,CMV感染率为33.70%,单因素分析结果显示,年龄≥40岁、重度IBD病情、广泛结肠型病变范围、糖皮质激素治疗、免疫抑制剂治疗、抗病毒治疗、激素依赖、结肠切除、临床治疗无效是IBD患者CMV感染的危险因素(P<0.05);多因素Logistic回归分析显示年龄≥40岁、重度IBD病情、广泛结肠型病变范围、糖皮质激素治疗、免疫抑制剂治疗是IBD患者CMV感染的独立危险因素;122例IBD合并CMV感染患者中gH 1型85例(69.67%)、gH 2型37例(30.33%);gH 1型与gH 2型IBD合并CMV感染患者的年龄≥40岁、广泛结肠型病变范围、糖皮质激素治疗、免疫抑制剂治疗、结肠切除结局以及激素依赖占比比较差异无统计学意义,而gH 1型患者病情严重程度比较差异有统计学意义(P<0.05),gH 1型与gH 2型患者的治疗有效率比较差异无统计学意义(χ²=0.017,P=0.895)。结论年龄≥40岁、重度病程、广泛结肠病变、糖皮质激素以及免疫抑制剂治疗会增加IBD患者CMV感染风险,IBD并CMV患者以gH1型为主,但gH基因分型不会影响临床疗效。

Risk factors for cytomegalovirus infection in patients with inflammatory bowel diseases

OBJECTIVE To explore the risk factors for cytomegalovirus(CMV) infection in the patients with inflammatory bowel disease(IBD) and analyze the correlation between genotypes of envelope glycoprotein H(gH) and clinical curative effect. METHODS A total of 362 patients with IBD who were treated in the First Affiliated Hospital of Hebei North University from Feb. 2015 to Dec. 2019 were enrolled in the study, the prevalence of CMV infection and clinical curative effect were investigated, multivariate logistic regression analysis was performed for risk factors for the CMV infection in the IBD patients, and the clinical characteristics and clinical curative effect of the IBD patients with different CMV gH genotypes were observed. RESULTS Of the 362 patients with IBD, 122 had CMV infection, and the incidence rate of CMV infection was 33.70%.The result of univariate analysis showed that no less than 40 years of age, severe IBD, range of extensive colonic lesions, glucocorticoid therapy, immunosuppressant therapy, antiviral therapy, hormone dependence, colectomy and ineffective clinical treatment were the risk factors for the CMV infection in the IBD patients(P<0.05).Multivariate logistic regression analysis indicated that no less than 40 years of age, severe IBD, range of extensive colonic lesions, glucocorticoid therapy and immunosuppressant therapy were the independent risk factors for the CMV infection in the IBD patients. Among the 122 IBD patients complicated with CMV infection, there were 85(59.67%) cases of gH 1 and 37(30.33%) cases of gH 2.There were no significant differences in the proportions of the patients with no less than 40 years of age, range of extensive colonic lesions, glucocorticoid therapy, immunosuppressant therapy, colectomy outcomes and hormone dependence between the gH 1-type IBD patients complicated with CMV infection and the gH 2-type patients, however, there was significant difference in the severity of disease among the gH 1-type patients(P<0.05);there was no significant difference in the effective rate of treatment between the gH 1-type patients and the gH 2-type patients(χ2=0.017,P=0.895). CONCLUSION No less than 40 years of age, severe disease course, extensive colonic lesions, glucocorticoid therapy and immunosuppressant therapy may increase the risk of CMV infection in the IBD patients.The H1 type is dominant among the IBD patients complicated with CMV infection, however, the gH genotype does not affect the clinical curative effect.