非亲缘异基因骨髓移植术后重症肠道急性移植物抗宿主病的内镜分析  

Endoscopic annlysis of acute graft versus host disease after nonrelative allogeneic bone marrow transplantation

作　　者：李楠[1] 沙立娜[1] 朱建华[1] 黄俊[1] 施兵[2] 

机构地区：[1]解放军总医院第二附属医院消化科,北京100091 [2]解放军总医院第二附属医院全军器官移植中心,北京100091

出　　处：《中国内镜杂志》2009年第2期140-142,145,共4页China Journal of Endoscopy

摘　　要：目的分析非亲缘异基因骨髓移植术后并发中、重度结肠炎内镜、病理特征及治疗情况。方法分析总结12例接受骨髓移植术后出现急性移植物抗宿主病(aGVHD)患者的内镜下表现资料。结果4例患者分别于移植后的1～57d并发不同程度中、重度结肠炎,肠镜和病理活检示结肠黏膜充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,诊断为结肠aGVHD。予以糖皮质激素为主的治疗,其中3例予FK506、抗CD3单克隆抗体治疗。2例出现血CMV抗原血症,给予更昔洛韦/磷甲酸钠治疗。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并发aGVHD所致结肠炎,诊断有赖于肠镜和病理活检并为正确治疗提供依据。ObjectiveThe endoscopic annlysis of acute graft versus host disease after nonrelative allogeneic bone marrow transplantation. MethodsThe endoscopic image were analyzed in 4 patients with acute graft versus host disease a （aGVHD）. Results4 patients were completed with middle and heavy intestional after transfertion 1～57 days. The hyperemia, edema and epithelial lamina necrosis were observed by endoscopic; the multiple ulcer of rec-tum and colon compled with more lymphocytes and plasmacytes infiltrate by pathology bioplsy. Without cy-tomegalovirus （CMV） Inclusion Bodiesand giant cells One of them occurred anti-CMV antigens-emia, ganciclovir/ Foscarnet Sodium were treated and was inefficiency, others effectiveness was controlled. ConclusionNonrelative allogene bone marrow transplantation complicating aGVHD lead to Enteritis, the diagnosis was depended to entero-scope and Pathology biopsy and is a proveyion for precision.

关 键 词：骨髓移植 异基因 移植物抗宿主病 急性 结肠炎 

分 类 号：R457.7[医药卫生—治疗学]