CAJ | 학술논문

目的探讨异基因造血干细胞移植(allo-HSCT)后肠道移植物抗宿主病(GI-GVHD)的结肠镜下表现尤其是特征性内镜表现以及组织学活检方式.方法对比性分析36例GI-GVHD患者结直肠与回肠末端间黏膜充血、水肿、糜烂、溃疡、龟裂样改变、剥脱等内镜表现以及各肠段黏膜凋亡细胞检出率.结果结直肠和回肠末端黏膜绝大多数有异常改变(97.2％比94.1％,P=0.609);黏膜充血多见于回肠末端(47.2％比79.4％,P=0.007),龟裂样改变主要见于结肠黏膜(63.9％比5.9％,P=0.000),黏膜水肿、糜烂和活动性出血发生率在结直肠和回肠末端相当(分别为97.2％比94.1％、80.6％比79.4％、47.2％比47.1％).具有GI-GVHD特征性改变的黏膜剥脱可见于76.5％(26/34)的患者,在结直肠和回肠末端发生率接近(52.8％比47.1％);结直肠黏膜剥脱周围全部伴有黏膜龟裂样改变.直肠、结肠和回肠末端黏膜凋亡细胞检出率分别为88.9％、91.3％和75.9％,回肠末端+直肠、回肠末端+结肠凋亡细胞检出率分别为88.2％和93.9％,只在回肠活检有可能不利于GI-GVHD的病理诊断(93.9％比75.9％,P=0.070).结论 allo-HSCT后GI-GVHD在结直肠和回肠末端的内镜表现并不一致;具有GI-GVHD特征性改变的黏膜剥脱并不少见;龟裂样改变也应是结直肠GVHD的特征性内镜表现;组织活检不应只钳取回肠末端组织,同时应活检结直肠黏膜.
목적 탐토이기인조혈간세포이식(allo-HSCT)후장도이식물항숙주병(GI-GVHD)적결장경하표현우기시특정성내경표현이급조직학활검방식.방법 대비성분석36례GI-GVHD환자결직장여회장말단간점막충혈、수종、미란、궤양、구렬양개변、박탈등내경표현이급각장단점막조망세포검출솔.결과 결직장화회장말단점막절대다수유이상개변(97.2％비94.1％,P=0.609);점막충혈다견우회장말단(47.2％비79.4％,P=0.007),구렬양개변주요견우결장점막(63.9％비5.9％,P=0.000),점막수종、미란화활동성출혈발생솔재결직장화회장말단상당(분별위97.2％비94.1％、80.6％비79.4％、47.2％비47.1％).구유GI-GVHD특정성개변적점막박탈가견우76.5％(26/34)적환자,재결직장화회장말단발생솔접근(52.8％비47.1％);결직장점막박탈주위전부반유점막구렬양개변.직장、결장화회장말단점막조망세포검출솔분별위88.9％、91.3％화75.9％,회장말단+직장、회장말단+결장조망세포검출솔분별위88.2％화93.9％,지재회장활검유가능불리우GI-GVHD적병리진단(93.9％비75.9％,P=0.070).결론 allo-HSCT후GI-GVHD재결직장화회장말단적내경표현병불일치;구유GI-GVHD특정성개변적점막박탈병불소견;구렬양개변야응시결직장GVHD적특정성내경표현;조직활검불응지겸취회장말단조직,동시응활검결직장점막.
Objective To investigate colonoscopic presentation and explore biopsy style of lower gastrointestinal graft-versus-host disease (GI-GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods The endoscopic findings including mucosa erythema,edema,erosion,ulcer,tortoiseshell-pattern and sloughing were observed in 36 patients with GI-GVHD and the rate of apoptotic cell yields in colon and end-ileum was calculated.Results Mucosa lesions were found in almost all of the patients both in colorectal and end-ileum (97.2％ vs 94.1％,P =0.609).Mucosa erythema was more often seen in end-ileum (47.2％ vs 79.4％,P =0.007) and tortoiseshell-pattern was mainly in colorectal mucosa (63.9％ vs 5.9％,P =0.000).Mucosa edema,erosion and oozing bleeding were the same prevalence in large intestine and end-ileum (97.2％ vs 94.1％,80.6％ vs 79.4％,47.2％ vs 47.1％,P ＞ 0.05,respectively).Sloughing was found in 76.5％ (26/34) GI-GVHD patients,and it was almost the same prevalence in large intestine and end-ileum (52.8％ vs 47.1％,P ＞0.05).Almost all of the colorectal mucosa sloughing located in the tortoiseshell-pattern mucosa.Rates of apoptotic cell in rectal,colonic and end-ileal mucosa were 88.9％,91.3％ and 75.9％,respectively,and the rates were 88.2％ and 93.9％ in ileum plus rectum and ileum plus colon respectively,showing that biopsy only in ileum was not sufficient for the pathologic diagnosis of GI-GVHD (93.9％ vs 75.9％,P =0.070).Conclusion Endoscopic presentations of GI-GVHD after allo-HSCT are not the same between colorectal and end-ileal mucosa.Sloughing with GIGVHD feature is not rarely seen in lower GI.Tortoiseshell-pattern mucosa should also be pathognomonic feature of colorectal GVHD in endoscopy.Pathologic tissue should not only be biopsied in end-ileum,but also in colorectal mucosa in the same time.