Leskinen R, Taskinen E, Volin L, Ruutu T, Häyry P
Transplantation Laboratory, University of Helsinki, Finland.
APMIS. 1992 Dec;100(12):1115-22. doi: 10.1111/j.1699-0463.1992.tb04048.x.
We have studied histological and immunohistological specimens of 39 skin biopsies from 21, and 30 rectal biopsies from 17 bone marrow transplant recipients. The biopsies were taken before transplantation, during acute and chronic graft-versus-host disease (GVHD), and at times with no GVHD. In biopsies taken during cutaneous aGVHD grade I to III, epithelial changes were seen in 16/23 biopsies. The cutaneous infiltrates during aGVHD consisted of CD2-, CD4-, CD8- and FMC-33-positive cells both in the epithelium and in the dermis. CD57-positive NK cells were also detected in most biopsies. During chronic GVHD the cutaneous cellular infiltrates were similar to those seen in moderate aGVHD, i.e. both CD4- and CD8-positive lymphoid cells were present. When the biopsy was taken after the beginning of corticosteroid treatment for aGVHD, or at times when the patient did not have GVHD symptoms, the cellular infiltrates were considerably smaller in the dermis. During clinical intestinal aGVHD mucosal epithelial changes were relatively uncommon; instead, increased numbers of both CD4- and CD8-positive lymphocytes in the lamina propria (LP) were seen in 11/13 samples. During chronic GVHD the number of CD4-positive cells exceeded that of CD8-positive cells in the LP, and the large lymphoid infiltrates also reached the muscularis mucosae. In rectal biopsies the differences were not so prominent because most of the pretransplant biopsies showed CD2-, CD4-, CD8- and CD57-positive lymphocytes both in the lamina propria and epithelium.
我们研究了21例骨髓移植受者的39份皮肤活检组织标本以及17例骨髓移植受者的30份直肠活检组织标本。活检标本分别在移植前、急性和慢性移植物抗宿主病（GVHD）期间以及无GVHD时采集。在皮肤急性GVHDⅠ至Ⅲ级期间采集的活检标本中，23份中有16份出现上皮改变。急性GVHD期间的皮肤浸润细胞在上皮和真皮中均由CD2、CD4、CD8和FMC - 33阳性细胞组成。大多数活检标本中也检测到CD57阳性自然杀伤细胞。慢性GVHD期间的皮肤细胞浸润与中度急性GVHD时相似，即同时存在CD4和CD8阳性淋巴细胞。当在开始针对急性GVHD进行皮质类固醇治疗后采集活检标本，或在患者无GVHD症状时采集活检标本时，真皮中的细胞浸润明显减少。在临床肠道急性GVHD期间，黏膜上皮改变相对少见；相反，在13份样本中有11份在固有层（LP）中发现CD4和CD8阳性淋巴细胞数量增加。慢性GVHD期间，LP中CD4阳性细胞数量超过CD8阳性细胞，并且大量淋巴细胞浸润也累及黏膜肌层。在直肠活检中，差异不那么明显，因为大多数移植前活检标本在固有层和上皮中均显示CD2、CD4、CD8和CD57阳性淋巴细胞。
