急性移植物抗宿主病－皮肤、肠粘膜活检病理学诊断

Biopsy examinations of skin and intestinal mucosa for pathological diagnosis of acute graft-versus-host disease

本文对１０例异基因骨髓移植后皮肤和肠粘膜发生ａＧＶＨＤ进行了病理学观察。皮肤和肠粘膜是便于６ＶＨＤ诊断与分度的靶组织。ａＧＶＨＤ主要使靶器官的上皮发生病理改变。皮肤表现为表皮细胞嗜酸性坏死和基底层细胞空泡性变，表皮发生裂隙、大泡形成以及真皮淋巴细胞浸润。肠道病变为腺窝上皮细胞坏死，腺体呈囊状，腺窝减少、或片状消失，根据皮肤和肠粘膜组织学病变的不同程度，将ａＧＶＨＤ分为Ⅰ～Ⅳ度。文中讨论了ａＧＶＨＤ与辐射损伤引起的病变的鉴别诊断。

The pathological changes were observed in the biopsics of skin and intestinal mucosa taken from 10 patients with acute graft-versus-host disease (aGVHD) following bone marrow transplantation. The skin and intestinal mucosa are the target tissues most accessible for the diagnosis and grading of aGVHD. The selectively damaged epithelia of target organs are the most prominent pathological manifestations. The skin showed eosinophilic necrosis of epidermal cells, vacuolar degeneration of epidermal basal cells, epidermal cleft, bulla and lymphocytic infiltration of the dermis.Intestinal lesions consisted of necrosis of crypt epithelium leading to crypt cystic formation and glandular depopulation or Patchy disappearance. On the basis of the degree of histological changes in the skin and intestinal mucosa. aGVHD could bc divided into I￣IV grades. The differential diagnosis between aGVHD and radiation lesion was also discussed.