异基因造血干细胞移植后肠道病变的内镜表现

目的探讨结肠镜检查在诊断异基因造血干细胞移植（allo-HSCT）后肠道移植物抗宿主病（GI-GVHD）和巨细胞病毒（CMV）肠炎中的作用。方法回顾性对比分析GI-GVHD、CMV肠炎以及GI-GVHD合并CMV肠炎（GC）的结肠镜检查表现及其相关问题。结果47例患者接受50例次结肠镜检查，其中GI-GVHD32例次，CMV肠炎7例次，GC11例次，他们的一般临床资料具有可比性（P〉0．1）；GI-GVHD、CMV肠炎和GC外周血CMV-DNA阳性率分别为28．1％、42．9％和27．3％，三组间差异没有统计学意义（P〉0．1）；肠镜下GI-GVHD和CMV肠炎都有结肠黏膜病变，病变表现呈多样性，除黏膜龟纹样改变和深在溃疡分别是GI-GVHD和CMV肠炎较为特异的病变外，黏膜水肿、红斑、充血、糜烂及浅表溃疡均不能区分GI-GVHD和CMV肠炎；3例GI-GVHD有伪膜形成，1例CMV肠炎有疱疹样黏膜隆起，GC患者容易发生回肠黏膜活动性渗血和回盲瓣炎症。GI-GVHD、CMV肠炎和GC分别有63．8％、70．0％和43．8％的活检标本取自直乙状结肠。结论allo-HSCT患者外周血CMV—DNA检查难以区分GI—GVHD和CMV肠炎；黏膜龟纹样改变和深在溃疡分别是GI-GVHD和CMV肠炎较为特异的改变；GC患者更容易发生回肠黏膜渗血和回盲瓣炎症。左半结肠检查及组织活检能诊断大部分GVHD和CMV感染，但最好进行全结肠检查并到达回肠末端。

The role of colonoscopy in diagnosis of gastrointestinal graft-versus-host disease and cytomegalovirus colitis after allergenic hematopoietic stem cell transplantation

Objective To investigate the role of colonoscopy in diagnosis of gastrointestinal graft -versus-host disease( GI-GVHD) and cytomegalovirus( CMV) colitis after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Analyze colonoscopic presentation of GI-GVHD and CMV colitis and GI-GVHD complicated with CMV colitis (GC) and their associated issues retrospectively and comparatively. Results Forty seven patients accepted 50 cases/times colonscopies, GI-GVHD was found in 32 of the 50 colonoscopies, CMV colitis in 7, and GC in 11, their demographic and clinical characteristics could be com-parable(P>0. 1). The positivity of peripheral blood CMV-DNA was 28. 1% in GI-GVHD, and that was 42. 9% and 27. 3% in CMV colitis and GC respectively, there were no significant differences among them(P > 0. 1). All the GI-GVHD and CMV colitis patients presented with a variety of colonic mucosal lesions. Besides the tortoiseshell-pattern mucosa and deep ulcer were characteristic lesions in GI-GVHD and CMV colitis respectively, the remaining mucosa lesions including edema, reddish patchy, erythma, erosion and superficial ulcer could not differentiate GI-GVHD from CMV colitis. Three GI-GVHD cases presented with pseud-omembrane, and 1 CMV colitis patient with herpes-like mucosa. Oozing bleeding of terminal-ileum mucosa and ileocecal valve inflammation could easily be found in GC patients. 63. 8% tissue samples were taken biopsies from rectosigmoid in GI-GVHD, and 70. 0% and 43. 8% in CMV colitis and GC patients respectively. Conclusion The positivity of peripheral blood CMV-DNA can not distinguish GI-GVHD from CMV colitis in allo-HSCT patients. GI-GVHD and CMV colitis manifest with a variety of lesions in colonoscopy, the tor- toiseshell-pattern mucosa in GI-GVHD and deep ulcer in CMV colitis are characteristic lesions. The patients of GI-GVHD complicated with CMV colitis readily present oozing bleeding of terminal-ileum mucosa and ileo-cecal valve inflammation. Colonoscopy and tissue biopsy of left-colon can diagnose the most of GI-GVHD and CMV colitis, but it's better to undertake pan-colon as well as terminal ileum examination for more accurate diagnosis.