骨髓移植术后急性肠道移植物抗宿主病内镜及病理学诊断研究

Endoscopic diagnosis of acute intestinal graft-versus-host disease following allogeneic bone marrow transplantation

目的评价内镜和病理学诊断在急性肠道移植物抗宿主病(GVHD)中的作用。方法回顾性总结和分析2001—2005年北京大学人民医院血液病学研究所临床已确诊的23例急性肠道GVHD患者的内镜及病理学资料。结果内镜下表现可分为:黏膜大致正常、血管纹理模糊或消失、弥漫性黏膜充血、水肿和脆性增加,重者出现糜烂、溃疡,甚至黏膜脱落或出血;病理学表现提示:隐窝上皮细胞凋亡、缺失,隐窝结构破坏,上皮和黏膜固有层不同程度的淋巴细胞浸润。结论内镜和病理学检查可以用于急性肠道GVHD的诊断,尤其是内镜在急性肠道GVHD的早期诊断方面具有重要作用,同时结合病理学检查最终确立诊断。

Objective At present study, we sought to further define the significance of endoscopic and pathological findings in the diagnosis of acute intestinal GVHD. Methods The clinical, endoscopic and pathological data in 23 patients with proven acute intestinal GVHD were retrospectively reviewed. Results The endoscopic features of the ileum and colon varied from being grossly normal, loss of vascular markings, diffuse mucosal erythema, edema and friability to erosion, ulceration, mucosal sloughing and bleeding. Pathological findings ineluded crypt epithelial cell apoptosis and dropout, crypt destruction and variable lymphocytic infihration of epithelium and lamina propria. Conclusion Endoscopic and pathological evaluation of the ileum and colon can be used to diagnose acute intestinal GVHD. Endoscopy may play a significant role in establishing early diagnosis for acute intestinal GVHD in patients following allogeneic BMT, but pathological evaluation of the ileal and colonic mucosa is needed to eonfirm the final diagnosis.