异基因造血干细胞移植后肠道病变的内镜表现  

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

作　　者：何晋德[1] 刘玉兰[1] 王智峰[1] 倪鹏燕[1] 刘代红[2] 陈欢[2] 陈育红[3] 

机构地区：[1]北京大学人民医院消化科,100044 [2]北京市道培医院血液科 [3]北京大学人民医院血液科,100044

出　　处：《中华消化内镜杂志》2006年第6期421-425,共5页Chinese Journal of Digestive Endoscopy

摘　　要：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-GVHD 32例次,CMV肠炎7例次,GC 11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。Objective To investigate the role of colonoscopy in diagnosis of gastrointestinal graftversus-host disease（GI-GVHD） and cytomegalovirus （CMV） colitis after allogeneic hematopeietic 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 comparable（ 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 pseudomembrane, 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 tortoiseshell-pattem 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 ileocecal valve inflammation. Colonoscopy and tissue biopsy of le

关 键 词：结肠镜检查 造血干细胞移植 移植物抗宿主病 巨细胞病毒 

分 类 号：R457.7[医药卫生—治疗学]