内镜在胃肠道移植物抗宿主病诊断中的价值

Endoscopic diagnosis of gastrointestinal graft-versus-host disease

目的 探讨内镜在异基因骨髓移植术后发生胃肠道移植物抗宿主病中的诊断价值,为临床治疗提供指导。方法 5例异基因骨髓移植术后患者出现胃肠道症状,怀疑存在胃肠道移植物抗宿主病,及时给予胃镜和(或)肠镜检查,同时,在胃窦、直乙状结肠及病灶明显处行组织病理学检查。结果 胃肠道移植物抗宿主病的临床表现主要有厌食、恶心、呕吐、水泻、腹痛等,少数患者可有消化道出血。内镜下胃黏膜呈水肿、充血、红斑及糜烂坏死。肠镜下结肠黏膜表现为弥漫性、连续性的水肿、充血和糜烂,可有浅表溃疡形成。组织学检查可见特征性的隐窝上皮细胞凋亡、缺失和淋巴细胞浸润。其病理变化可呈弥漫性或局灶性。结论 内镜结合组织病理学检查可诊断异基因骨髓移植患者的胃肠道移植物抗宿主病。

Objective To evaluate the significace of endoscopic diagnosis of gastrointestinal graft-versus-host disease ( GI GVHD) resulted from allogeneic bone marrow transplantation. Methods Five patients with suspected GI GVHD received endoscopic examination and biopsies were taken from antrum, sig-moid colon or the focal lesions. Results The symptoms of GI GVHD included anorexia, nausea, vomiting, watery diarrhea, abdominal pain, GI bleeding etc. The endoscopic appearance in stomach varied from subtle mucosal edema, hyperemia, and erythema necrotic erosion. Besides the above stated, the endoscopic appearance in colon also presented with diffuse mucosal erosion, hemorrhege and ulcer. Histological findings included characteristically crypt epithelial cell apoptosis and sloughing, and lymphocyte infiltration in epithelium and lamina propria. The involvement may be varied from diffuse to focal in stomach or colon. Conclusion Endoscopic and histological evaluation of the stomach and colon and biopsy specimen can be used as the evidences in diagnosing GI GVHD.