Chirletti P, Caronna R, Arcese W, Iori A P, Calcaterra D, Cartoni C, Sammartino P, Stipa V
Surgical Pathology IX, Policlinico Umberto I University of Rome La Sapienza, Italy.
Leuk Lymphoma. 1998 Mar;29(1-2):129-37. doi: 10.3109/10428199809058388.
Acute intestinal graft-versus-host disease (GVHD) develops in about 30-50% of allogeneic bone-marrow transplant recipients: 10-20% have gastrointestinal emergencies (hemorrhage or perforation). Mortality reaches 30-60% in patients with acute, grade 2-4 GVHD. We studied 36 bone marrow recipients in whom acute intestinal GVHD developed. Seven had gastrointestinal emergencies: 4 severe gastrointestinal bleeding and 3 acute peritonitis. Three patients with gastrointestinal bleeding and one patient with peritonitis responded to medical therapy. Three needed surgery: one with bleeding and two with peritonitis, while 1 patient had embolization. Of the 7, two patients died, one after embolization and one after surgery. Two of the three surgically-treated cases are still alive several years after operation. From this experience we feel that surgery for gastrointestinal bleeding in acute GVHD is indicated only when medical treatment fails. Severe neutropenia, thrombocytopenia (<10.000 x mm3) and blood cultures positive for CMV have an unfavorable prognostic value.
急性肠道移植物抗宿主病（GVHD）发生在约30%-50%的异基因骨髓移植受者中：10%-20%会出现胃肠道急症（出血或穿孔）。急性2-4级GVHD患者的死亡率达30%-60%。我们研究了36例发生急性肠道GVHD的骨髓移植受者。7例出现胃肠道急症：4例严重胃肠道出血和3例急性腹膜炎。3例胃肠道出血患者和1例腹膜炎患者经药物治疗有效。3例需要手术：1例出血患者和2例腹膜炎患者，另有1例接受了栓塞治疗。7例患者中，2例死亡，1例在栓塞治疗后死亡，1例在手术后死亡。3例接受手术治疗的患者中有2例术后存活数年。基于此经验，我们认为仅在药物治疗无效时才考虑对急性GVHD所致胃肠道出血进行手术。严重中性粒细胞减少、血小板减少（<10000/mm³）以及CMV血培养阳性具有不良预后价值。
