Dumler J S, Beschorner W E, Farmer E R, Di Gennaro K A, Saral R, Santos G W
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Pathol. 1989 Dec;135(6):1097-103.
The presence of an erythematous skin rash and hemorrhagic complications in acute graft-versus-host disease (GVHD) suggest that the vasculature may be involved in the immunopathologic process. We reviewed endothelial and vascular histopathologic changes on light microscopy and on immunoperoxidase stained sections of skin biopsies obtained from 41 HLA-identical allogeneic marrow transplant recipients with at least grade 2 GVHD. Biopsies taken from 14 allogeneic HLA-identical bone marrow transplant recipients who never developed GVHD were used as controls. Sections were evaluated for evidence of immunologic vascular injury using the rank file analysis of histologic features, expression of HLA-DR antigen, and the distribution of fibrin and factor VIII-related antigen (F VIII RAg). Patients with acute GVHD had significantly greater intimal lymphocytic infiltrates, perivascular nuclear dust deposition, perivascular F VIII Rag extravasation and deposition and vascular proliferation than controls. We find significantly greater endothelial injury in GVHD patients, which may represent primary immunologic injury to the vasculature. The clinical findings in acute GVHD probably result from cumulative endothelial as well as epithelial injury.
急性移植物抗宿主病（GVHD）中出现的皮肤红斑疹和出血并发症提示脉管系统可能参与了免疫病理过程。我们回顾了41例至少有2级GVHD的HLA相同的同种异体骨髓移植受者皮肤活检组织在光学显微镜和免疫过氧化物酶染色切片上的内皮和血管组织病理学变化。取自14例从未发生GVHD的HLA相同的同种异体骨髓移植受者的活检组织用作对照。使用组织学特征的列队分析、HLA - DR抗原的表达以及纤维蛋白和因子VIII相关抗原（F VIII RAg）的分布来评估切片中免疫性血管损伤的证据。急性GVHD患者的内膜淋巴细胞浸润、血管周围核尘沉积、血管周围F VIII Rag外渗和沉积以及血管增殖明显多于对照组。我们发现GVHD患者的内皮损伤明显更严重，这可能代表脉管系统的原发性免疫损伤。急性GVHD的临床发现可能是内皮和上皮累积损伤的结果。
