Роль агрессивности ВЗК у пациентов с ЦМВ (Цитомегаловирусом)

Active cytomegalovirus infection diagnosed by real-time PCR in patients with inflammatory bowel disease: a prospective, controlled observational study.

Abstract

OBJECTIVE:

It is assumed that cytomegaloviral (CMV) infection in inflammatory bowel disease (IBD) is caused by reactivation due to the immunosuppressive therapy, but the role of CMV as a pathophysiological factor and prognostic marker in IBD is unclear. The aim of this study was to investigate CMV infection in IBD, with real-time polymerase chain reaction (PCR) and immunohistochemistry, with emphasis on newly diagnosed disease.

MATERIALS AND METHODS:

In this prospective, controlled study, 67 patients with IBD and 34 control patients with irritable bowel syndrome (IBS) or rectal bleeding were included. Serology for CMV was analysed along with CMV DNA in plasma, mucosal biopsies, and faeces. Mucosal biopsies were further analysed with histopathology and CMV immunohistochemistry.

RESULTS:

Detection of CMV IgM was more common in patients with IBD, compared to controls, 21% versus 3%. CMV DNA was found in 16% of patients with newly diagnosed, untreated IBD and in 38% of steroid-treated patients. Four of the five patients that needed urgent surgery were CMV-DNA positive in at least one of three sample types. None of the controls had detectable CMV DNA.

CONCLUSIONS:

Active CMV infection was found in high proportions of newly diagnosed untreated patients with IBD, in patients on immunosuppression and in patients in the need of surgery. Low CMV-DNA levels in non-immunosuppressed patients were not a risk factor for the development of more severe IBD, while the detection of CMV DNA in patients on immunosuppressive therapy may foresee disease progression.

KEYWORDS:

CMV; Crohn’s disease; Cytomegalovirus; immunohistochemistry; inflammatory bowel disease; real-time PCR; ulcerative colitis;

PMID:
27142339
DOI:
10.3109/00365521.2016.1156154

Роль агрессивности ВЗК у пациентов с ЦМВ (Цитомегаловирусом)

МАТЕРИАЛЫ И МЕТОДЫ:
В этом проспективном, исследовании, были включены 67 пациентов с ВЗК (IBD) и 34 пациента контроля с синдромом раздраженной толстой кишки СРК (IBS) или кровотечением из прямой кишки. Серология для CMV была проанализирована наряду с ДНК CMV в плазме, относящихся к слизистой оболочке биопсиях (биопат) и фекалиях. Биопаты слизистой были далее проанализированы с гистопатологией и иммуногистохимией ЦМВ (CMV).

РЕЗУЛЬТАТЫ:
Обнаружение ЦМВ (CMV), IgM было более распространено у больных с ВЗК (IBD, по сравнению с контрольными группами, 21% против 3%. ДНК ЦМВ была найдена в 16% пациентов с недавно диагностированным, НЕЛЕЧЕННЫМ ВЗК и в 38% рассматриваемых со стероидом пациентов.
Четыре из пяти пациентов, которые нуждались в неотложной операции, была ЦМВ-ДНК положительная реакция, по крайней мере в одном из трех типов.
Ни у одного, из контрольных групп, не было обнаружено ДНК ЦМВ.

ЗАКЛЮЧЕНИЯ:

Активная инфекция ЦМВ была найдена в высоких процентах, впервые диагностированных нелеченных ВЗК пациентов, у больных на ИММУНОСУПРЕССОРАХ и у больных, требующих хирургиического лечения.
Низкие уровни ЦМВ-ДНК в неиммуносупрессивных пациентах не были фактором риска, для развития более тяжелого ВЗК, в то время как обнаружение ДНК — ЦМВ у больных на иммунодепрессивной терапии можно предвидеть развитие болезни.

 

ИСТОЧНИК

 

Adalimumab as induction therapy for Crohn’s disease — one center study].

Abstract

Adalimumab is a subcutaneously administered recombinant fully human monoclonal antibody targeting tumor necrosis factor alpha. It has been approved for use in Poland to treat patients with Crohn’s disease under the program of Polish National Health Found since 2010.

AIM:

The aim of this study was to evaluate the efficacy of adalimumab monotherapy for inducing clinical remission in patients with active Crohn’s disease . The primary outcome assessment was the reduction in score to 150 or below on the Crohn’s Disease Activity Index (CDAI) at 12 weeks and the secondary one was the reduction in ΔCDAI of at least 100 points.

MATERIALS AND METHODS:

From January 2011 to December 2015 we treated 68 patients with active Crohn’s disease (mean CDAI score 359). All the patients came from region of Silesia, an area with the same environment conditions. The patients were given adalimumab (Humira, AbbVie) subcutaneously at a dose of 160 mg at week 0, 80 mg at week 4 and 40 mg every two weeks thereafter.

RESULTS:

Twenty eight patients (41%) had a clinical remission at week 12 (CDAI ≤150) and 33 patients (49%) had a ΔCDAI response. During the 12-week of induction therapy infection with Clostridium difficile occurred in 4 patients and one patient died of a severe CMV infection.

CONCLUSIONS:

Adalimumab is effective as induction therapy for patients with moderate-to-severe Crohn’s disease, however in individual cases serious infections including CMV infection can occur. A potential predictive factors for response can be female gender, non-smoking status and high CRP level at baseline.

KEYWORDS:

Crohn’s disease; anti TNF-alfa therapy

PMID:
27883347
[Indexed for MEDLINE]

Адалимумаб эффективен как терапия для пациентов с умеренной-к-тяжелой болезнью Крона, однако в отдельных случаях могут проявиться, серьезные инфекции включая инфекцию ЦМВ (цитамегаловирус).

ИСТОЧНИК

Клинические врачи должны знать о возможности параллельной инфекции ЦМВ, леча пациентов с острым обострением неспецифического язвенного колита НЯК, не отвечающего на лечение по стандартной схеме.

MATERIALS AND METHODS:
It was a prospective study of patients diagnosed as ulcerative colitis presenting with acute exacerbation of symptoms (cases) and those who were in remission (controls). A detailed evaluation of the disease history including personal history, treatment compliance and clinical disease severity were noted. Investigations including blood routine, endoscopic examination with biopsy, histopathological examination and immunohistochemistry for CMV were done on the biopsy sample

A total of 58 patients with ulcerative colitis were studied which included 37 cases and 21 controls. Out of the various clinical and demographic parameters, Good treatment compliance (p =0.0003) and Perceived Stress Scale (PSS) score (p=0.0001) showed significant difference between cases and controls. Basic laboratory parameters {Haemoglobin level, Total Leucocyte Count (TLC) and Erythrocyte Sedimentation Rate (ESR)}, clinical disease severity predictors (Truelove and Witt’s criteria, Mayo score and endoscopic disease severity grade) and Geboes histological scoring showed significant difference between cases and controls. The prevalence of CMV colitis in our study was only 5.4% (two cases).
CONCLUSION:
Clinical and endoscopic disease severity indicators can be used as predictors of histological activity in ulcerative colitis. Poor treatment compliance and stress are important risk factors for acute exacerbation of ulcerative colitis. Clinicians should be aware of the possibility of concurrent CMV infection while treating patients with acute exacerbation of ulcerative colitis not responding to the conventional management. Reduced prevalence of CMV colitis in cases of acute exacerbation of ulcerative colitis in our study may be due to the small sample size, reduced number of steroid dependent cases or reduced severity of our cases.

 

ИСТОЧНИК

2 комментария к записи «Роль агрессивности ВЗК у пациентов с ЦМВ (Цитомегаловирусом)»

  1. Пингбэк: Герпес: что с этим делать? | Жизнь с ВЗК (Болезнь Крона)

  2. Пингбэк: Что нужно знать больному ВЗК? | Жизнь с ВЗК (Болезнь Крона)

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