Bertheau P, Hadengue A, Cazals-Hatem D, Devergie A, Schenmetzler C, Degos F, Erlinger S, Gluckman E, Degott C
Service d'Anatomie Pathologique, Hôpital Beaujon, Clichy, Paris, France.
Bone Marrow Transplant. 1995 Aug;16(2):261-5.
From 1984 to 1991, 514 patients were treated by BMT in 1 center. 254 patients survived more than 3 months and, in 38 patients, 47 liver biopsies were performed for chronic liver dysfunction characterized by cholestasis. The aim of the present study was to evaluate the possible causes of liver disease at the time of biopsy. One clinician analyzed clinical data and was able to propose up to 3 diagnoses including GVHD, viral hepatitis, drug-related hepatitis, chronic veno-occlusive disease (VOD) or other. Two pathologists reviewed histologic sections and were also able to propose up to 3 diagnoses. Clinically, 1, 2 or 3 diagnoses were proposed in 30, 60 and 10% of cases, respectively. Pathologically, 1, 2 or 3 diagnoses were proposed in 13, 62 and 25%, respectively. Histologic changes of GVHD were present in 40 of 47 biopsies and concordance between the clinician and the pathologists on the presence of GVHD lesions was found in 77% of biopsies. Viral hepatitis was proposed 22 times by the clinician and 19 times by pathologists. Viral hepatitis, usually hepatitis C, was associated with GVHD in 16 cases. Diagnoses of chronic VOD and drug-related hepatitis were proposed less often. In summary, more than 1 diagnosis was suggested for many of the patients studied, GVHD being the most frequent. The simultaneous presence of GVHD, viral diseases, chronic VOD and drug-induced diseases could explain the high incidence of cholestasis in the long-term post-BMT.
1984年至1991年期间，某中心对514例患者进行了骨髓移植治疗。254例患者存活超过3个月，其中38例患者因胆汁淤积所致慢性肝功能障碍接受了47次肝脏活检。本研究的目的是评估活检时肝病的可能病因。一名临床医生分析临床数据，最多可提出3种诊断，包括移植物抗宿主病（GVHD）、病毒性肝炎、药物性肝炎、慢性静脉闭塞病（VOD）或其他。两名病理学家复查组织切片，也最多可提出3种诊断。临床上，分别有30%、60%和10%的病例提出了1种、2种或3种诊断。病理上，分别有13%、62%和25%的病例提出了1种、2种或3种诊断。47例活检中有40例存在GVHD的组织学改变，77%的活检中临床医生和病理学家在GVHD病变的存在上达成一致。临床医生提出病毒性肝炎22次，病理学家提出19次。病毒性肝炎，通常为丙型肝炎，在16例中与GVHD相关。慢性VOD和药物性肝炎的诊断提出较少。总之，许多研究患者被提出不止1种诊断，GVHD最为常见。GVHD、病毒性疾病、慢性VOD和药物性疾病同时存在可解释骨髓移植后长期胆汁淤积的高发病率。
