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目的探讨巨细胞病毒(Cytomegalovirus,CMV)感染状态、病毒载量对炎症性肠病(Inflammatory bowel disease,IBD)患者肠道黏膜损伤程度及临床活动度的影响。方法 回顾性纳入2023年1月至2025年12月于本院就诊的246例IBD患者，根据肠道黏膜CMV感染情况分为CMV阳性组(82例)和CMV阴性组(164例)。所有患者均行血清CMV-IgM/IgG抗体检测、外周血及黏膜组织CMV-DNA定量检测、肠道黏膜组织HE染色及CMV早期抗原免疫组化检测。比较两组患者的临床活动度评分(改良Mayo评分/CDAI评分)、内镜评分(Mayo内镜评分/SES-CD评分)及病理损伤评分(改良Geboes评分)，采用多因素Logistic回归分析IBD患者重度临床活动度的独立危险因素。结果 CMV阳性组82例患者中，血清CMV-IgM阳性32例(39.02%),CMV-IgG阳性78例(95.12%)；外周血CMV-DNA阳性37例(45.12%)，病毒载量中位数为1.26×103拷贝数/mL(5.82×102～3.57×103拷贝数/mL)；黏膜组织CMV-DNA阳性82例(100%)，病毒载量中位数为8.74×104拷贝/mg(2.15×104～2.63×105拷贝/mg)。UC患者：CMV阳性组的改良Mayo评分显著高于CMV阴性组(P<0.05)；活动性感染亚组的改良Mayo评分显著高于潜伏感染亚组(P<0.05)。CD患者：CMV阳性组的CDAI评分显著高于CMV阴性组(P<0.05)；活动性感染亚组的CDAI评分显著高于潜伏感染亚组(P<0.05)。临床活动度分层分析显示，CMV阳性组中重度活动期患者比例显著高于CMV阴性组(UC:46.94%vs12.62%,P<0.05;CD:45.45%vs14.75%,P<0.05)。UC患者：CMV阳性组的Mayo内镜评分显著高于CMV阴性组(P<0.05)；活动性感染亚组的Mayo内镜评分显著高于潜伏感染亚组(P<0.05)。CD患者：CMV阳性组的SES-CD评分显著高于CMV阴性组(P<0.05)；活动性感染亚组的SES-CD评分显著高于潜伏感染亚组(P<0.05)。CMV阳性组的改良Geboes评分显著高于CMV阴性组(P<0.05)；活动性感染组的病理评分显著高于潜伏感染组(P<0.05)。多因素Logistic回归分析结果显示，黏膜CMVDNA高载量(≥1×105拷贝/mg)和CMV活动性感染是IBD患者重度临床活动度的独立危险因素(P<0.05)。结论CMV感染尤其是黏膜高病毒载量与活动性感染IBD患者的临床活动度及肠道黏膜损伤程度密切相关，是IBD患者发生重度临床活动度的独立危险因素。早期检测肠道黏膜CMV感染状态及病毒载量，及时给予抗病毒治疗，有助于改善IBD患者的临床预后。
Abstract：Objective This study was designed to evaluate the association of cytomegalovirus(CMV) infection status and viral load with the severity of intestinal mucosal injury and clinical disease activity in patients with inflammatory bowel disease(IBD). Methods A retrospective cohort of 246 IBD patients treated at our institution from January 2023 to December 2025 was enrolled, who were classified into CMV-positive(n=82) and CMV-negative(n=164) groups based on mucosal CMV infection. All individuals underwent serum CMV-IgM/IgG antibody assays, quantitative CMV-DNA measurement in peripheral blood and mucosal tissue, haematoxylin-eosin staining, and immunohistochemical detection of CMV early antigen in intestinal mucosal tissue. Comparison was made for the clinical activity scores(modified Mayo score and Crohn's Disease Activity Index [CDAI]), endoscopic scores(Mayo endoscopic score and SES-CD score), and pathological injury score(modified Geboes score) of the two groups. Multivariate logistic regression was applied to identify independent risk factors for severe clinical activity in the overall IBD patients. Results Among the 82 CMV-positive patients, 32 cases(39.02%) were tested to be serum CMV-IgM positive and 78 cases(95.12%) CMV-IgG positive. 37 patients(45.12%) were positive for peripheral blood CMV-DNA, with a median viral load of 1.26×103 copies/mL(5.82×102– 3.57×103 copies/mL). All 82 patients(100%) were positive for mucosal CMV-DNA, showing a median load of 8.74×104 copies/mg(2.15×104 – 2.63×10 5 copies/mg). For UC patients, the modified Mayo score of the CMV-positive group was significantly higher than that of the CMV-negative group(P<0.05), and the active-infection subgroup exhibited a higher modified Mayo score than the latent-infection subgroup(P<0.05). For CD patients, the CDAI score of the CMV-positive group was significantly higher than that of the CMV-negative group(P<0.05), and the active-infection subgroup exhibited a higher CDAI score than the latent-infection subgroup(P<0.05). Stratified analysis of clinical activity revealed that the proportion of patients with severe active disease in the CMV-positive group was markedly greater than that in the CMV-negative group(UC: 46.94% vs. 12.62%, P<0.05; CD: 45.45% vs. 14.75%, P<0.05). For UC patients, the Mayo endoscopic score of the CMV-positive group was significantly higher than that of the CMV-negative group(P<0.05), and the active-infection subgroup exhibited a higher Mayo endoscopic score than the latent-infection subgroup(P<0.05). For CD patients, the SES-CD score of the CMV-positive group was significantly higher than that of the CMV-negative group(P<0.05), and the active-infection subgroup exhibited a higher SES-CD score than the latent-infection subgroup(P<0.05). The modified Geboes score of the CMV-positive group was significantly higher than that of the CMV-negative group(P<0.05), and the active-infection subgroup exhibited a significantly higher pathological score(modified Geboes) than the latent-infection subgroup(P<0.05). Multivariate logistic regression identified high mucosal CMV-DNA load (≥1×105 copies/mg) and active CMV infection as independent risk factors for severe clinical activity in IBD patients(P<0.05). Conclusion CMV infection, particularly the mucosal viral load, is closely correlated with the clinical activity and intestinal mucosal injury in IBD patients with active infection, and serves as an independent risk factor of severe disease activity. Early detection of the CMV infection status and viral load of the intestinal mucosa, and appropriate antiviral intervention, may contribute to the improved clinical outcomes of IBD patients.
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中图分类号:R574;R511
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[1]李辰,王玉静,毛建娜,等.巨细胞病毒感染在炎症性肠病患者肠道黏膜损伤及临床活动度中的作用分析[J].病毒学报().
2026-09-07
2026-09-07
2026-09-07