難治性潰瘍性大腸炎におけるサイトメガロウイルス感染症―その診断，治療と経過

Cytomegalovirus Infection in Intractable Ulcerative Colitis: Its Diagnosis, Treatment and Course

要旨　中等症以上の潰瘍性大腸炎（ulcerative colitis ; UC）の連続例でサイトメガロウイルス（cytomegalovirus ; CMV）感染を合併した症例の臨床像，抗ウイルス剤の治療効果，長期経過について検討した．CMVの感染率は32.0％（41/128）と高率であった．臨床的には感染例は非感染例に比べ高齢であった．また，ステロイド抵抗性症例に感染例が多くCMV感染がUCの難治性要因であることが示唆された．抗ウイルス剤の治療効果については，感染例41例中32例（78.0％）に投与したが，その有効率は64.3％と比較的高率であり感染例に対しては早期に抗ウイルス剤を投与すべきである．しかし，いったん治療に成功しても，中等度以上の再燃を来した場合，再度CMV感染を合併していることが多く，徐々に難治化する傾向がみられた．以上，難治性UCの治療に際しCMV感染を考慮することが必要である．

　We report characteristic clinical features and treatment of consecutive patients with moderate to severe active primary or recurrent cytomegalovirus infection complicating ulcerative colitis. Effectiveness of ganciclovir on CMV patients was also examined over a long-term period. The rate of CMV-infection was found to be high (32.0％ ; 41/128). Comparison of the CMV infected and non-infected group showed that incidences of CMV infection were higher among those who are relatively of advanced age. Also, incidences of CMV infection were seen in patients with steroid-resistance, which suggests that cytomegalovirus-infection might cause patients with ulcerative colitis to be intractable. Moreover, high incidences of CMV infection in patients who were administered steroid suggest that compromised immune function caused by the administration of steroids might be associated with CMV infection. The high effective rate of ganciclovior on CMV infection (64.3％) suggests that it is necessary for CMV infection to be treated with ganciclovir in the early stage. However, after successful treatment, patients surffered recurrance of CMV infection over the long term course and such patients tended to be intractable.