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. 2020 May;99(5):1121-1128. doi: 10.1007/s00277-020-03966-y. Epub 2020 Mar 4.
To measure histological villous atrophy and to clarify the diagnostic accuracy of endoscopic villous atrophy in gastrointestinal graft-versus-host disease.
Data for patients who underwent upper and/or lower endoscopic examinations after hematopoietic stem cell transplantation were retrospectively collected. In study 1, group A included 56 patients in whom GI-GVHD was histologically confirmed and group B included 60 patients in whom GI-GVHD was not histologically confirmed. Group C included 59 patients before HSCT. The lengths of villi and crypts in the duodenum and terminal ileum were histologically measured. In study 2, the diagnostic accuracies of villous atrophy of the duodenum and of the terminal ileum using magnifying endoscopy were evaluated.
In study 1, the lengths of villi and the villi/crypt (V/C) ratios of the duodenum and terminal ileum in group A were significantly smaller than those in the other groups (p < 0.05). V/C ratio was moderately correlated with clinical severity, histological grades, and endoscopic grades in the terminal ileum. In study 2, the diagnostic accuracies of magnified images for villous atrophy were 83.8% in the duodenum and 94.9% in the terminal ileum.
Magnifying endoscopy enables evaluation of villous atrophy and is useful for optical biopsy of GVHD.
测量组织学绒毛萎缩，并阐明内镜下绒毛萎缩在胃肠道移植物抗宿主病中的诊断准确性。
回顾性收集了造血干细胞移植后接受上消化道和/或下消化道内镜检查的患者的数据。在研究 1 中，A 组包括 56 例经组织学证实的胃肠道移植物抗宿主病患者，B 组包括 60 例未经组织学证实的胃肠道移植物抗宿主病患者，C 组包括 59 例造血干细胞移植前患者。测量十二指肠和回肠的绒毛和隐窝长度。在研究 2 中，评估了放大内镜下十二指肠和回肠绒毛萎缩的诊断准确性。
在研究 1 中，A 组患者的十二指肠和回肠的绒毛长度和绒毛/隐窝（V/C）比值明显小于其他组（p<0.05）。V/C 比值与回肠的临床严重程度、组织学分级和内镜分级中度相关。在研究 2 中，放大图像对绒毛萎缩的诊断准确率在十二指肠为 83.8%，在回肠为 94.9%。
放大内镜能够评估绒毛萎缩，对移植物抗宿主病的光学活检有帮助。
