gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2021-20-3-28-34gnck-1651Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВлияние цитомегаловирусной инфекции на течение язвенного колита средней и тяжелой степениEffect of cytomegalovirus infection on moderate and severe ulcerative colitishttps://orcid.org/0000-0002-8803-7566АлександровТ. Л.AlexandrovT. L.

Александров Т.Л.

ул. Саляма Адиля, д. 2, г. Москва, 123423

Timofei L. Alexandrov

Salyama Adilya str., 2, Moscow, 123423

polikarpova-e@yandex.ruhttps://orcid.org/0000-0003-1697-4670НанаеваБ. А.NanaevaB. A.

Нанаева Б.А.

ул. Саляма Адиля, д. 2, г. Москва, 123423

Bella A. Nanaeva

Salyama Adilya str., 2, Moscow, 123423

https://orcid.org/0000-0003-2013-8798БарановаТ. А.BaranovaT. A.

Баранова Т.А.

ул. Саляма Адиля, д. 2, г. Москва, 123423

Tatyana A. Baranova

Salyama Adilya str., 2, Moscow, 123423

ТишаеваИ. А.TishaevaI. A.

Тишаева И.А.

ул. Саляма Адиля, д. 2, г. Москва, 123423

Irina A. Tishaeva

Salyama Adilya str., 2, Moscow, 123423

https://orcid.org/0000-0001-5694-1051ПодольскаяД. В.PodolskayaD. V.

Подольская Д.В.

ул. Саляма Адиля, д. 2, г. Москва, 123423

Daria V. Podolskaya

Salyama Adilya str., 2, Moscow, 123423

ПедаЕ. С.PedaE. S.

Педа Е.С.

ул. Саляма Адиля, д. 2, г. Москва, 123423

Ekaterina S. Peda

Salyama Adilya str., 2, Moscow, 123423

https://orcid.org/0000-0001-7250-0977КнязевО. В.KnyazevO. V.

Князев О.В.

ул. Саляма Адиля, д. 2, г. Москва, 123423

шоссе Энтузиастов, д. 86, г. Москва, 111123

Oleg V. Knyazev

Salyama Adilya str., 2, Moscow, 123423

Entusiastov shosse, 86, Moscow, 111123

https://orcid.org/0000-0003-1172-6221ШапинаМ. В.ShapinaM. V.

Шапина М.В.

ул. Саляма Адиля, д. 2, г. Москва, 123423

Marina V. Shapina

Salyama Adilya str., 2, Moscow, 123423

ФГБУ "НМИЦ колопроктологии имени А.Н.Рыжих" Минздрава РоссииРоссияRyzhih National Medical Research Center of ColoproctologyRussian FederationФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииРоссияRyzhih National Medical Research Center of ColoproctologyRussian FederationФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава России; ГБУЗ «МКНЦ имени А.С. Логинова» ДЗМРоссияRyzhih National Medical Research Center of Coloproctology;Russian Federation2021210920212032834Copyright © Александров Т.Л., Нанаева Б.А., Баранова Т.А., Тишаева И.А., Подольская Д.В., Педа Е.С., Князев О.В., Шапина М.В., 20212021Александров Т.Л., Нанаева Б.А., Баранова Т.А., Тишаева И.А., Подольская Д.В., Педа Е.С., Князев О.В., Шапина М.В.Alexandrov T.L., Nanaeva B.A., Baranova T.A., Tishaeva I.A., Podolskaya D.V., Peda E.S., Knyazev O.V., Shapina M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1651

ЦЕЛЬ ИССЛЕДОВАНИЯ: изучить влияние цитомегаловирусной (ЦМВ) инфекции на течение среднетяжелой и тяжелой атак язвенного колита (ЯК).ПАЦИЕНТЫ И МЕТОДЫ: проведено одноцентровое проспективное когортное исследование с сентября 2018 г. по декабрь 2020 г. В исследование включались пациенты со среднетяжелой и тяжелой атаками ЯК. Всем пациентам проводили колоноскопию с биопсией для количественного определения ДНК ЦМВ методом полимеразной цепной реакции (ПЦР). В дальнейшем пациенты были разделены на подгруппы: с наличием ЦМВ (ЦМВ+) и его отсутствием (ЦМВ–). В подгруппе ЦМВ+ проводилась противовирусная терапия с оценкой вирусологических, клинических и эндоскопических результатов на 19-й день терапии, через месяц после ее завершения и через 6 месяцев. В подгруппе ЦМВ– эти результаты оценивались через 6 месяцев.РЕЗУЛЬТАТЫ: в исследование включено 126 пациентов. ЦМВ был выявлен у 51 (40,5%) пациента. При этом на его присутствие не влияли ни пол, ни возраст, ни ранее проводимая пациентам терапия. Лабораторные показатели в обеих подгруппах были сопоставимы, как и тяжесть течения ЯК. Выявлено достоверное повышение риска развития гормональной резистентности у пациентов ЦМВ+ с тяжелой атакой ЯК (ОШ 1,33; 95% ДИ: 1,059–19,4). Эффективность противовирусной терапии составила 60,8%. Все пациенты, не ответившие на противовирусную терапию, были оперированы. При этом среди пациентов, у которых противовирусная терапия была эффективна (достигнута эрадикация вируса) необходимости в хирургическом лечении не возникало.ВЫВОДЫ: ЦМВ инфекция достоверно увеличивает вероятность развития гормональной резистентности у пациентов с тяжелой атакой ЯК, при этом, все пациенты, ответившие на противовирусную терапию, не нуждались в проведении хирургического лечения. Необходимо дальнейшее проведение многоцентровых рандомизированных исследований.

AIM: to evaluate the effect of cytomegalovirus (CMV) infection on the course of moderate and severe flare ups of ulcerative colitis (UC).PATIENTS AND METHODS: a prospective cohort single-center study was done in September 2018 — December 2020. The study included patients with moderate and severe flare ups of UC. All patients underwent colonoscopy with biopsy to quantify CMV DNA by polymerase chain reaction (PCR). Subsequently, the patients were divided into subgroups: with the presence of CMV (CMV+) and its absence (CMV–). In the CMV+ subgroup, antiviral therapy was carried out with an assessment of virological, clinical and endoscopic results on the 19th day of therapy, one month after its completion and after 6 months. In the CMV– subgroup these results were evaluated after 6 months only.RESULTS: the study included 126 patients. CMV was detected in 51 (40.5%). At the same time, its presence was not influenced by gender, age, or previous therapy. Laboratory indicators in both subgroups were comparable, as well as the severity of UC. A significant increase in the risk of developing steroid resistance was revealed in CMV+ patients with severe UC attack (OR 1.33, 95% CI: 1.059–19.4). The effectiveness of antiviral therapy was 60.8%. All patients who did not respond to antiviral therapy underwent surgery. At the same time, among patients in whom antiviral therapy was effective (virus eradication was achieved), there was no need for surgery.CONCLUSION: CMV infection significantly increases the likelihood of developing steroid resistance in patients with severe flare up of UC, while all patients who responded to antiviral therapy did not require surgery. Further multicenter randomized trials are needed.

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The authors declare that there are no conflicts of interest present.