Matsuda Kana, Ono Shoko, Ishikawa Marin, Miyamoto Shuichi, Abiko Satoshi, Tsuda Momoko, Yamamoto Keiko, Kudo Takahiko, Shimizu Yuichi, Hayase Eiko, Hashimoto Daigo, Teshima Takanori, Matsuno Yoshihiro, Sakamoto Naoya
Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine, Nishi-7, Kita-15, Kita-ku, Sapporo, 060-8638, Japan.
Division of Endoscopy, Hokkaido University Hospital, Nishi-7, Kita-15, Kita-ku, Sapporo, 060-8638, Japan.
Ann Hematol. 2018 May;97(5):877-883. doi: 10.1007/s00277-018-3241-9. Epub 2018 Jan 16.
Although graft-versus-host disease (GVHD) is the major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), cytomegalovirus (CMV) reactivation also occurs in patients after allo-HSCT and these conditions often clinically overlap. The aim of this study was to determine reliable endoscopic findings of CMV colitis in patients with gastrointestinal graft-versus-host-disease (GI-GVHD). Patients after allo-HSCT who were histologically confirmed to have GI-GVHD with or without CMV colitis and patients with an immunosuppressive condition were retrospectively analyzed. We divided the patients into three groups: GI-GVHD with CMV colitis (group A), GI-GVHD without CMV colitis (group B), and CMV colitis without undergoing allo-HSCT (group C). From medical records, the involved colorectal areas and endoscopic findings according to the groups were compared. A total of 70 patients were divided into three groups (group A: n = 19, group B: n = 28, group C: n = 23). Mucosal injuries in groups A and C frequently occurred in the cecum including ileocecal valves. On the other hand, there were no abnormal lesions on ileocecal valves in group B. Furthermore, ulcer lesions were more frequently observed in groups A and C than in group B (p < 0.001). The sensitivity and specificity of mucosal injuries in the cecum for prediction of CMV colitis were 89.5 and 76.5%, respectively, and mucosal injuries in the cecum were more reliable findings than CMV antigenemia. Ulcer lesions in the cecum are reliable endoscopic findings for CMV colitis in patients with GI-GVHD after allo-HSCT.
尽管移植物抗宿主病（GVHD）是异基因造血干细胞移植（allo-HSCT）的主要并发症，但巨细胞病毒（CMV）再激活也会在allo-HSCT后的患者中发生，并且这些情况在临床上常常相互重叠。本研究的目的是确定胃肠道移植物抗宿主病（GI-GVHD）患者中CMV结肠炎可靠的内镜检查结果。对组织学确诊为有或无CMV结肠炎的allo-HSCT后患者以及有免疫抑制情况的患者进行回顾性分析。我们将患者分为三组：伴有CMV结肠炎的GI-GVHD（A组）、不伴有CMV结肠炎的GI-GVHD（B组）以及未接受allo-HSCT的CMV结肠炎（C组）。根据病历，比较各组累及的结肠区域和内镜检查结果。总共70例患者被分为三组（A组：n = 19，B组：n = 28，C组：n = 23）。A组和C组的黏膜损伤常发生于包括回盲瓣的盲肠。另一方面，B组回盲瓣未见异常病变。此外，A组和C组比B组更频繁观察到溃疡病变（p < 0.001）。盲肠黏膜损伤预测CMV结肠炎的敏感性和特异性分别为89.5%和76.5%，且盲肠黏膜损伤比CMV抗原血症是更可靠的发现。盲肠溃疡病变是allo-HSCT后GI-GVHD患者CMV结肠炎可靠的内镜检查结果。
