CT增强扫描鉴别异基因骨髓移植术后腹部GVHD和机遇性感染（英文）  

The abdominal GVHD and opportunistic infection following allogeneic bone marrow transplantation: Differentiation with enhanced CT scan

作　　者：李相生[1] 樊红霞[1] 方红[1] 宋云龙[1] 时惠平[1] 祝红线[1] 朱玲[2] 

机构地区：[1]中国人民解放军空军总医院CT室,北京100142 [2]中国人民解放军空军总医院血液科,北京100142

出　　处：《现代肿瘤医学》2014年第3期649-656,共8页Journal of Modern Oncology

摘　　要：目的:比较骨髓移植术后腹腔移植物抗宿主病(GVHD)和机遇性感染的CT表现以确定有助于鉴别诊断的CT特点。方法:纳入25例腹腔GVHD和15例腹腔机遇性感染患者,机遇性感染包括巨细胞病毒性感染(n=4)、真菌性感染(n=6)及细菌性感染(n=5)。对所有病人进行CT扫描。CT征象包括肠壁增厚、异常黏膜增强、肠管扩张、大量积液、胆管扩张、腹水以及邻近肠系膜条状征。分析病变的位置和范围。对两组病人的CT征象进行对照分析。结果:在胃肠道不连续性多发分布多见于GVHD;而连续性分布多见于机遇性感染(P<0.05)。胆管扩张是GVHD最常见的肠道外病变,然而非常少见于机遇性感染(P<0.05)。皮肤斑丘疹见于60%的GVHD,但是不见于机遇性感染(P<0.05)。对没有皮肤病变的病人,肠管病变的不连续分布和胆管扩张更多见于GVHD。结论:GVHD和机遇性感染的CT征象有较大重叠,尽管如此,一些临床和CT征象,例如皮肤斑丘疹、胆管扩张和肠管病变的不连续多发分布有利于诊断GVHD。Objective：To compare the CT manifestations of abdominal graft - versus - host disease（GVHD） and opportunistic infection following allogeneic bone marrow transplantation and to identify the CT features that are helpful for the differential diagnosis. Methods：The study population comprised 25 patients with abdominal GVHD and 15 pa- tients with abdominal opportunistic infection including cytomegalovirus infection（n=4） ,fungal infection（n=6） and bacterial infection（n=5）. CT examinations were performed for all the patients. All the images were analyzed for CT patterns including thickening of intestinal wall, abnormal mucosal enhancement,intestinal dilatation, excessive fluid filling,biliary dilatation,ascites and adjacent mesenteric stranding. The location and extent of abnormalities were not- ed. These CT manifestations were compared between the GVHD group and the opportunistic infection group. Results： The discontinuous distribution of the pathologies in the multiple segments of gastrointestinal tract was more common in GVHD, but continuous distribution was more common in opportunistic infection （P 〈 0.05）. Dilatation of bile duct was the most common extra- intestinal finding in GVHD,whereas rarely seen in opportunistic infection（P 〈 0.05）. Skin maculopapular eruption was seen in 60.0% of the patients with GVHD and no patient with opportunistic infection（P 〈0.05）. The discontinuous distribution of intestinal abnormalities or biliary dilatation was more common in the GVHD patients without skin lesions than in the patient with opportunistic infection. Conclusion：There are great over- lap in the CT manifestations between abdominal GVHD and opportunistic infection. Nevertheless,the clinical and CT manifestations such as skin maculopapular eruption, dilatation of bile duct and discontinuous distribution of the pathol- ogy in the multiple segments of gastrointestinal tract are helpful for the diagnosis of GVHD.

关 键 词：移植物抗宿主病(GVHD) 机遇性感染 骨髓移植 CT 

分 类 号：R730.5[医药卫生—肿瘤]