骨髓移植术后急性移植物抗宿主病的肠镜及病理表现

目的 探讨非亲缘异基因骨髓移植术后出现肠道症状的急性移植物抗宿主病(GVHD)患者的结肠镜、病理特征及治疗情况.方法 分析总结4例急性GVHD中、重度肠道受损患者的内镜病理资料.结果 4例患者分别于移植后的21～57 d发生不同程度肠道黏膜受损所致的腹痛、腹泻等症状,肠镜和活检病理示肠黏膜允血水肿或上皮层坏死脱落,肠腔正常结构消失,直、结肠多发性溃疡,见较多淋巴细胞和浆细胞浸润,未见巨细胞病毒(CMV)包涵体和巨细胞,诊断为急性GVHD.予以糖皮质激素等治疗,1例治疗无效死亡,其余得到有效控制.结论 非亲缘异基因骨髓移植后发生急性GVHD的肠道受损,诊断有赖于肠镜和活检病理,据此及时正确治疗后多能得到有效控制.

Endoscopic and pathologic findings in acute graft versus host disease after allogeneic bone marrow transplantation

Objective To analyze the endoscopic and pathologic characters of acute graft versus host disease(aGVHD) after aUogeneie bone marrow transplantation.Methods The endoscopic and pathologic findings of 4 patients with acute aGVHD were retrospectively analyzed.Results The clinical manifestations of 4 patients were abdominal pain and diarrhea occurred 21～57 days after bone marrow transplantation.The eolonoseopy detected mucosa edema,erosion and multiple ulcers.The pathological findings included epithelial necrosis accompanied with infiltration of lympbocytes and plasmacytes,no cytomegalovirus was found in biopsies,and aGVHD was diagnosed.Three patients recovered after the treatment with corticosteroids,while the other one died.Conclusion The intestine is involved in aGVHD after allogeneie bone marrow transplantation,and the diagnosis depends on eolonoscopy and biopsy.