Shulman H M, Sharma P, Amos D, Fenster L F, McDonald G B
Department of Pathology, Fred Hutchinson Cancer Research Center, Seattle, Washington 98104.
Hepatology. 1988 May-Jun;8(3):463-70. doi: 10.1002/hep.1840080305.
We tested the hypothesis that liver histology from patients with graft-versus-host disease could be distinguished from other common liver diseases. Liver biopsies from 33 allogeneic marrow transplant recipients with acute and chronic graft-versus-host disease and 37 nontransplant liver disease patients without graft-versus-host disease were recut, restained and coded for blind review. Analysis of individual histologic features showed significantly more cytologic aberration of bile duct epithelium and more cholestasis among biopsies with graft-versus-host disease when compared to biopsies without graft-versus-host disease (p less than or equal to 0.05). The duration of graft-versus-host preceding the biopsy influenced the histologic features. Biopsies before Day 35 showed frequent acidophilic bodies but infrequent bile duct changes. Biopsies from Days 35 to 90 posttransplant had more frequent bile duct exocytosis and disruption, and biopsies from patients with chronic graft-versus-host disease (beyond Day 90) showed more frequent portal fibrosis and bile duct dropout. Pattern assessment of coded biopsies showed that a histologic diagnosis of graft-versus-host disease had a positive predictive value of 86%, a sensitivity of 66% and a specificity of 91%. False-negative diagnoses occurred most frequently in biopsies obtained less than 4 weeks posttransplant, usually because bile duct abnormalities were not present. False-positive diagnoses of graft-versus-host disease occurred in nongraft-versus-host disease biopsies with periportal inflammation and proliferated bile ducts. However, biopsies of chronic graft-versus-host disease had more frequent dropout and disruption of bile duct epithelium than did biopsies of acute or chronic hepatitis.(ABSTRACT TRUNCATED AT 250 WORDS)
我们检验了这样一个假设，即移植物抗宿主病患者的肝脏组织学特征可以与其他常见肝脏疾病相区分。对33例患有急慢性移植物抗宿主病的同种异体骨髓移植受者以及37例无移植物抗宿主病的非移植肝病患者的肝脏活检标本进行重新切片、重新染色，并进行编码以便盲法评估。对个体组织学特征的分析显示，与无移植物抗宿主病的活检标本相比，有移植物抗宿主病的活检标本中胆管上皮的细胞学异常显著更多，胆汁淤积也更多（p小于或等于0.05）。活检前移植物抗宿主病的持续时间会影响组织学特征。移植后35天之前的活检标本显示嗜酸性小体常见，但胆管改变少见。移植后35至90天的活检标本中胆管胞吐和破坏更常见，而慢性移植物抗宿主病患者（移植后90天之后）的活检标本显示门脉纤维化和胆管缺失更常见。对编码活检标本的模式评估显示，移植物抗宿主病的组织学诊断阳性预测值为86%，敏感性为66%，特异性为91%。假阴性诊断最常发生在移植后不到4周获取的活检标本中，通常是因为不存在胆管异常。移植物抗宿主病的假阳性诊断发生在伴有门周炎症和胆管增生的非移植物抗宿主病活检标本中。然而，慢性移植物抗宿主病的活检标本中胆管上皮的缺失和破坏比急性或慢性肝炎的活检标本更常见。（摘要截取自250词）
