Clinical Analysis Of Ulcerative Colitis Complicated With Cytomegalovirus Infection

Background Ulcerative colitis(UC)is one type of the inflammatory bowel disease,which is characterized by diffuse and continuous intestinal lesions,and has the clinical feature of recurrence-relieving-recurrence.Cytomegalovirus(CMV),an opportunistic infectious agent of the Herpes virus family,has an infection-latent-reactivation profile and is easily activated in immunodeficiency patients.The link between cytomegalovirus infection and ulcerative colitis has been discovered more than 50 years.As more and more immunosuppressive drugs keep using in recent years,the risk of CMV infection has also increased,which is still the focus of attention and debate of clinicians nowadays.The possibility for CMV infection to affect the disease progression and clinical outcome of UC,surely has aroused widespread clinical concern.Aims The aim of our study is to analyze a series of the clinical characteristics of UC patients complicated with CMV infection and to explore the correlation between UC and CMV infection and then find out the possible risk factors.Hopefully it can provide physicians with new ideas and methods for the clinical diagnosis and treatment in UC patients with CMV infection.Methods In this study,patients with ulcerative colitis hospitalized in Nanfang Hospital affiliated to Southern Medical University from January 2013 to January 2018 were searched.Patients with serological or intestinal CMV tests were selected and we found that all CMV infected ones are moderate or severe UC patients.Those patients were divided into CMV-infected group and non-CMV-infected group.Both of the groups should collect the information of CMV infection,demographic characteristics,clinical features,endoscopic performance,treatment strategy,and the prognosis.In order to find out the possible relationship between UC and CMV infection,the statistical analysis was used for our study included the Chi-square test,Mann-Whitney U test and other statistical methods.Besides,we used Logistic regression analysis for risk factors in UC patients with CMV infection.P value less than 0.05 was considered to be statistically significant.Results 1.The infection and detection situation:A total of 206 patients with UC were screened by serological or intestinal CMV tests.Among them,79 patients were mild or in remission period,and 127 patients with moderate or severe UC.There were 21 patients with CMV infection and all of them were moderate or severe UC patients.The incidence of CMV infection in moderate and severe UC patients was 16.5%.In the CMV-infected group,the positive rate of serum IgM was 31.3%,the positive rate of serum CMV DNA was 80%,and the positive rate of the CMV DNA in intestinal tissue was 80%.2.Clinical manifestation:Among the 127 patients with moderate and severe UC,21 patients were in the CMV-infected group and others in the non-CMV-infected group.Compared with the non-CMV-infected group,the disease severity in the CMV-infected group was significantly higher(P=0.013),and among which 20 cases were severe UC.The rate of steroid dependence and the rate of steroid resistance were higher in the CMV-infected group than in the non-CMV-infected group(P=0.016,P<0.001).In the CMV-infected group,both the utilization rates of immunosuppressive agents and infliximab before the onset were significantly more than the non-CMV-infected group(P<0.001,P=0.005).Besides,the CMV-infected group had more utilization proportion of immunosuppressive agents treatment and infliximab treatment within a month before the onset(P<0.001,P=0.002).The median BMI in the CMV-infected group was 17.8,and the median ALB was 30.7g/L,significantly lower than that of the non-infected group(P=0.035,P=0.014).The median CRP in the CMV-infected group was 41.5mg/L,significantly higher than that of non-infected group(P=0.004).3.The treatment during inpatient admission and prognosis:In the CMV-infected group,the use of glucocorticoid and immunosuppressive agents were significantly more than that of the non-infected group(P=0.048,p=0.006).In comparison with the non-infected group,diarrhea in CMV-infected group after treatment was more severe(P=0.007).Besides,the median CRP after re-examination in the CMV-infected group was 11.2 mg/L and significantly higher than the other group(P=0.015).The median hospital stay was 12 days,which was much longer than that of the non-infected group(P=0.003).4.Risk factors:ALB≥30g/L was an independent protection factor for CMV infection in moderate or severe UC patients(OR=0.211,95%CI 0.054～0.816,P=0.024).Moreover,the use of azathioprine and the use of infliximab within a month before the onset and steroid resistance were independent risk factors for CMV infection(P=0.007,OR=35.852;P<0.001,OR=32.086;P=0.042,OR=4.420).Conclusion CMV infection occurs more in patients with severe UC,and it can play an important role in the process of UC and trend to induce adverse clinical outcomes.ALB≥30g/L can reduce the risk for CMV infection in UC patients.The CMV infection is more likely to occur in patient with steroid resistance or with azathioprine or infliximab therapy within a month before the onset.Clinically we should be alert to patients with risk factors for CMV infection,screen and monitor the infection and use antiviral drugs in time.