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題 名 | Clinical and Endoscopic Features for Almentary Tract Cytomegalovirus Disease: Report of 20 Cases with Gastrointestinal Cytomegalovirus Disease=胃腸道巨大細胞病毒疾病的臨床與內視鏡診斷之特徵:二十個病例研究 |
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作 者 | 林蔚然; 蘇銘堯; 許振銘; 何玉彬; 顏嘉慧; 邱正堂; 陳邦基; | 書刊名 | 長庚醫學 |
卷 期 | 28:7 2005.07[民94.07] |
頁 次 | 頁476-484 |
分類號 | 415.5091 |
關鍵詞 | 巨大細胞病毒; 腸胃道; 潰瘍; 腸道狹窄; Cytomegalovirus; CMV; Gastrointestinal tract; GI tract; Ulcer; Colonic stricture; |
語 文 | 英文(English) |
中文摘要 | 背景:巨大細胞病毒是人類常見的病毒感染,但是臨床上卻很少造成嚴重胃腸道疾病。此研究目的在探討胃腸道巨大細胞病毒疾病之樂床表現,內視鏡下的病變型態,病患預後及追蹤內視鏡之發現。 方法:從民國76年至民國92年,回溯性於一林口長庚醫學中心收集到20例胃腸道巨大細胞病毒疾病病例。這些病例皆接受上消化道或下消化道內視鏡檢查與黏膜生檢,經由病理切片發現巨大細胞併細胞核內包涵體與/或免疫組織化學染色確定巨大細胞病毒疾病。 結果:這20例胃腸道巨大細病毒疾病患者,男性15例,女性5例,平均年齡51.1士25.3歲(歲圍5個月大至87歲)。患者中有免疫功能缺失或使用免疫抑制劑7例(35%),癌症接受化學治療3例(15%),敗血症4例(20%),其他6例。9例接受胃鏡檢查,6例接受乙狀結腸鏡檢查,5例接受全大腸鏡檢查。接受內視鏡檢查原因為消化道出血11例(55%),腹痛5例(25%),腹瀉2例(10%),腹脹1例(5%),吞嚥疼痛1例(5%)。病變部位食道1例,胃8例,腸11例;其中胃以胃竇部最見(75%;6/8),而大腸以乙狀結腸與直腸最常見(63.6%;7/11)。病變型態可分為黏膜發炎型3例(15%),潰瘍型9型(45%)。黏膜發炎併潰瘍型7例(35%),與黏膜下腫瘤併潰瘍型1例(5%) 。在17名有潰瘍病變的患者中,有10例有多發的(潰瘍數大瘤於2個)潰瘍病變,有大潰瘍(潰瘍直徑大於2公分)12例,有7例合併有多變的大潰瘍。6例有腸巨大潰瘍病變患者於下消化道內視視鏡追蹤檢查時,有2例併發現重腸腔狹窄。 結論:嚴重胃腸道巨大細胞病毒疾病患者常有免疫功能缺失或敗血症,臨床症狀以出血最常見。病變部位以乙狀結腸,直腸與胃竇部最常見,病變型態以潰瘍型與黏膜發炎併潰瘍型為主,常有的潰瘍病變。對於下消化道巨大細胞病毒感染的診斷能力,乙狀結腸鏡不如大腸鏡。有達端大腸大潰瘍病變可能併發嚴重腸腔狹窄。有巨大細胞毒腸炎的病患建議追蹤大腸鏡檢查。 |
英文摘要 | Background: The clinical presentations and endoscopic features of cytomegalovirus (CMV) infection in the gastrointestinal (GI) tract are diverse, and can mimic other inflammatory gastrointestinal diseases. Methods: From 1987 to 2003 at Chang-Gung Medical Center, 20 patients with CMV infections of the GI tract who were assessed using endoscopic examinations and diagnosed via pathologic studied were retrospectively reviewed. Results: Most of the patients were adults with immunocompromised conditions (10/20). GI tract bleeding was the most common clinical manifestation (11/20). Five patients presented with abdominal pain, and two patients presented with diarrhea. Fifteen patients suffered from fever. The endoscopic abnormalities could be classified into four main groups: inflammatory mucosa alone (3/20), ulceration alone (7/20), inflammatory mucosa associated with ulcer (9/20) and sub-mucosal tumor with ulcer (1/20). Of the 17 patients with ulcer lesions, ten had multiple ulcers and 12 had large ulcers exceeding 2 centimeters in diameter. Of the six patients followed up with colonoscopy, one was free of disease, one had a single ulcer, and four had colitis and were CMV positive on repeat biopsy. Two patients had colon strictures with persistent CMV colitis. Conclusion: Many patients with GI tract CMV infection are immunicompromised. Gastrointestinal bleeding is the most common initial presentation of gastrointestinal CMV disease. Fever is the most common associated toxic sign. Sigmoidoscopy cannot replace colonoscopy for detecting CMV colitis. The most common feature is multiple ulcers with at least one large ulcer. Endoscopic follow-up in patients with CMV colitis is recommended to investigate for possible persistent colitis and strictures. |
本系統中英文摘要資訊取自各篇刊載內容。