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目的 探讨内镜在异基因骨髓移植术后发生胃肠道移植物抗宿主病中的诊断价值,为临床治疗提供指导。方法 5例异基因骨髓移植术后患者出现胃肠道症状,怀疑存在胃肠道移植物抗宿主病,及时给予胃镜和(或)肠镜检查,同时,在胃窦、直乙状结肠及病灶明显处行组织病理学检查。结果 胃肠道移植物抗宿主病的临床表现主要有厌食、恶心、呕吐、水泻、腹痛等,少数患者可有消化道出血。内镜下胃黏膜呈水肿、充血、红斑及糜烂坏死。肠镜下结肠黏膜表现为弥漫性、连续性的水肿、充血和糜烂,可有浅表溃疡形成。组织学检查可见特征性的隐窝上皮细胞凋亡、缺失和淋巴细胞浸润。其病理变化可呈弥漫性或局灶性。结论 内镜结合组织病理学检查可诊断异基因骨髓移植患者的胃肠道移植物抗宿主病。
Objective To investigate the diagnostic value of endoscopy in gastrointestinal graft-versus-host disease after allogeneic bone marrow transplantation and provide guidance for clinical treatment. Methods Gastrointestinal symptoms were observed in 5 patients with allogeneic bone marrow transplantation. Gastrointestinal graft-versus-host disease was suspected and gastroscopy and / or colonoscopy were given in time. In addition, gastric antrum, straight sigmoid colon and obvious lesions Histopathological examination. Results The main clinical manifestations of gastrointestinal graft-versus-host disease were anorexia, nausea, vomiting, watery diarrhea and abdominal pain. A few patients had gastrointestinal bleeding. Endoscopic gastric mucosa was edema, congestion, erythema and erosion necrosis. Enteric colon mucosa showed diffuse, continuous edema, congestion and erosion, there may be superficial ulcer formation. Histological examination revealed characteristic crypt epithelial cell apoptosis, deletion and lymphocyte infiltration. The pathological changes can be diffuse or focal. Conclusion Endoscopy combined with histopathology can diagnose gastrointestinal graft-versus-host disease in allogeneic bone marrow transplantation patients.