Background

Cytomegalovirus (CMV) infection has been associated with steroid-refractory disease and risk for colectomy in patients with Ulcerative Colitis (UC). We aimed to study if patients with latent CMV infection more often needed systemic steroids, immunomodulators, biologics and surgery than patients negative for CMV infection.

Methods

From the national IBD register (SWIBREG) all patients with UC (n = 404) treated at Umeå University Hospital in Sweden, and who were tested for CMV infection were included. A latent CMV infection was defined if a patient had at least one positive serology and/or a positive PCR for CMV. A retrospectively medical chart review between the years 2006 and 2019 was performed to check for medical therapy and surgery due to UC.

Results

One hundred and thirty-one patients (32%) had at least on one occasion been tested for CMV infection and of these patients, 88 (67%) had evidence of a latent CMV infection. There were no differences in the use of systemic steroids, in the use of immunomodulators/biologics or in colectomy rate between patients with latent CMV infection and patients with no infection (table). There were no differences between patients with latent CMV infection vs. no infection in median faecal calprotectin (FC) levels the first five years after diagnosis (302 vs. 457 µg/g; p = 0.301) or at the last recorded FC test (62 vs. 82 µg/g; p = 0.317).Latent CMV infection (n = 88)No CMV infection (n = 43)p-valueMean age years (SD)42.3 (9.2)40.4 (7.8)0.246Female gender43% (n = 38)49% (n = 21)0.541Montreal classificationA116% (n = 14)19% (n = 8)0.913A279% (n = 69)76% (n = 32A35% (n = 4)5% (n = 2)E113% (n = 11)7% (n = 3)0.378E219% (n = 17)23% (n = 10)E368% (n = 60)70% (n = 30)Medical treatment (ever)Five-ASA95% (n = 84)95% (n = 41)0.978Thiopurines56% (n = 49)60% (n = 26)0.603Anti-TNF26% (n = 23)26% (n = 11)0.946Vedoluzimab3% (n = 3)2% (n = 1)>0.999Median numbers of courses with systemic steroids (25^th-75^th percentile)1.5 (0–4.0)2.0 (0–3.5)0.950Colectomy12% (n = 11)9% (n = 4)0.772

Conclusion

Patients with latent CMV infection do not differ from CMV negative patients in the use of medical therapy for UC nor in colectomy rate.

中文翻译：

---

P459巨细胞病毒潜伏感染对溃疡性结肠炎患者疾病行为的影响

背景

溃疡性结肠炎（UC）患者的巨细胞病毒（CMV）感染与类固醇难治性疾病和结肠切除术的风险相关。我们旨在研究与CMV感染阴性的患者相比，潜在CMV感染患者是否更需要全身性类固醇，免疫调节剂，生物制剂和手术治疗。

方法

根据国家IBD登记册（SWIBREG），纳入了在瑞典于默奥大学医院接受治疗的所有UC患者（n = 404），并对其进行了CMV感染检测。如果患者至少具有一种针对CMV的阳性血清学和/或PCR阳性，则定义为潜在的CMV感染。在2006年至2019年之间进行了回顾性医学图表审查，以检查由于UC引起的药物治疗和手术。

结果

131位患者（32％）至少有一次接受了CMV感染测试，其中88位（67％）表现出潜在的CMV感染。潜在的CMV感染患者和未感染的患者在使用全身性类固醇，使用免疫调节剂/生物制剂或结肠切除率方面无差异（表）。在诊断后的前五年（302 vs. 457 µg / g； p = 0.301）或最后记录的FC测试中，潜在的CMV感染患者与未感染的粪便钙卫蛋白（FC）水平无差异。 vs. 82 µg / g； p = 0.317）。潜在的CMV感染（n = 88）没有CMV感染（n = 43）p值平均年龄（SD）42.3（9.2）40.4（7.8）0.246女性性别43％（n = 38）49％（n = 21）0.541蒙特利尔分类A116％（n = 14）19％（n = 8）0。^个-75^个百分点）1.5（0-4.0）2.0（0-3.5）0.950Colectomy12％（N = 11）9％（N = 4）0.772

结论

潜在CMV感染患者在使用药物治疗UC和结肠切除率方面与CMV阴性患者没有区别。