Department of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, University Hospital Freiburg, Hugstetter Street 55, Freiburg, Germany.
Bone Marrow Transplant. 2012 Mar;47(3):430-8. doi: 10.1038/bmt.2011.137. Epub 2011 Jun 27.
Diagnosis of acute intestinal GVHD (aGVHD) following allogeneic hematopoietic cell transplantation is based on clinical symptoms and histological lesions. This retrospective analysis aimed to validate the 'Freiburg Criteria' for the endoscopic grading of intestinal aGVHD. Grade 1: no clear-cut criteria; grade 2: spotted erythema; grade 3: aphthous lesions; and grade 4: confluent defects, ulcers, denudation of the mucosa. Having excluded patients with infectious diarrhea, we evaluated 175 consecutive patients between January 2001 and June 2009. Setting a cutoff between grade 1 (no change in therapy) and grade 2 (intensification of immunosuppression), macroscopy had a sensitivity of 89.2% (95% confidence interval (CI): 80.4-94.9%), a specificity of 79.4% (95% CI: 69.6-87.1%), a positive-predictive value of 79.6% (95% CI: 70.0-87.2%) and a negative-predictive value of 89.0% (95% CI: 80.2-94.9%). In all, 20% of patients with aGVHD in the lower gastrointestinal tract (GIT) had lesions only in the terminal ileum. In all patients with aGVHD ≥2 of the upper GIT, typical lesions were also found in the lower GIT. Ileo-colonoscopy showed the highest diagnostic yield for aGVHD. In conclusion, the 'Freiburg Criteria' for macroscopic diagnosis of intestinal aGVHD provide high accuracy for identifying aGVHD ≥2.
急性移植物抗宿主病（aGVHD）的诊断基于临床症状和组织学病变。本回顾性分析旨在验证“弗莱堡标准”用于内镜评估肠道 aGVHD 的分级。1 级：无明确标准；2 级：点状红斑；3 级：口疮样病变；4 级：融合性缺损、溃疡、黏膜剥落。排除感染性腹泻患者后，我们评估了 2001 年 1 月至 2009 年 6 月期间的 175 例连续患者。在 1 级（治疗无变化）和 2 级（免疫抑制强化）之间设定一个截止值，宏观检查的敏感性为 89.2%（95%置信区间（CI）：80.4-94.9%），特异性为 79.4%（95% CI：69.6-87.1%），阳性预测值为 79.6%（95% CI：70.0-87.2%），阴性预测值为 89.0%（95% CI：80.2-94.9%）。在所有下消化道（GIT）发生 aGVHD 的患者中，有 20%的患者只有末端回肠有病变。在所有 GIT 上部发生 aGVHD≥2 的患者中，下部 GIT 也发现了典型病变。回结肠镜检查对 aGVHD 的诊断率最高。总之，“弗莱堡标准”用于宏观诊断肠道 aGVHD 具有较高的准确性，可识别 aGVHD≥2。
