Ichiki Yasunori, Bowlus Christopher L, Shimoda Shinji, Ishibashi Hiromi, Vierling John M, Gershwin M Eric
Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, TB192, One Shields Avenue, Davis, CA 95616, USA.
Autoimmun Rev. 2006 Jan;5(1):1-9. doi: 10.1016/j.autrev.2005.02.006. Epub 2005 Apr 21.
Graft-versus-host disease (GVHD), induced by the reaction of donor T cells to recipient histoincompatible antigens, is a serious complication of allogeneic bone marrow transplantation (BMT), resulting in considerable morbidity and mortality. In MHC-disparate BMT, donor T cells directly react with major histocompatibility complex (MHC) antigens, while in MHC-matched BMT, T cells react with minor histocompatibility antigens (miHA) presented by shared MHC molecules. Clinically, acute and chronic GVHD can be distinguished on the basis of the time of onset, clinical manifestations and distinct pathobiological mechanisms. Acute GVHD usually occurs within 2 to 6 weeks following allogeneic BMT and primarily affects the skin, liver and the gastrointestinal tract with T cell infiltration of the epithelia of the skin, mucous membranes, bile ducts and gut. In addition, hair follicle cells, airways, bone marrow, and a variety of other tissue systems can be involved. Acute GVHD occurs in up to 50% of allogeneic HLA-matched and 70% of HLA-disparate BMT recipients despite prophylactic immunosuppressive drugs. Chronic GVHD involves a wider range of organs and clinical manifestations include scleroderma, liver failure, immune complex disease, glomerulonephritis, and autoantibody formation.
移植物抗宿主病（GVHD）是由供体T细胞对受体组织相容性抗原的反应所诱导，是异基因骨髓移植（BMT）的一种严重并发症，会导致相当高的发病率和死亡率。在主要组织相容性复合体（MHC）不相合的BMT中，供体T细胞直接与主要组织相容性复合体（MHC）抗原发生反应，而在MHC相合的BMT中，T细胞与共享MHC分子所呈递的次要组织相容性抗原（miHA）发生反应。临床上，急性和慢性GVHD可根据发病时间、临床表现和不同的病理生物学机制加以区分。急性GVHD通常发生在异基因BMT后的2至6周内，主要影响皮肤、肝脏和胃肠道，T细胞浸润皮肤、黏膜、胆管和肠道的上皮组织。此外，毛囊细胞、气道、骨髓以及多种其他组织系统也可能受累。尽管使用了预防性免疫抑制药物，但在高达50%的异基因HLA相合以及70%的HLA不相合BMT受者中仍会发生急性GVHD。慢性GVHD累及的器官范围更广，临床表现包括硬皮病、肝功能衰竭、免疫复合物病、肾小球肾炎和自身抗体形成。
