Gastro-intestinal toxicity related to bone marrow transplantation: Disruption of the intestinal barrier precedes clinical findings
Gastro-intestinal toxicity related to bone marrow transplantation: Disruption of the intestinal barrier precedes clinical findings
复制标题
DOI：
10.1038/sj.bmt.1700765
复制
发表时间：
1997-05-01
影响因子：
4.8
通讯作者：
Ekman, T
中科院分区：
文献类型：
--
作者：
Johansson, JE;Ekman, T
与骨髓移植相关的强化细胞毒性治疗诱导了与肠道通透性增加一致的肠道严重损伤。目前，通过检查口腔和记录源自胃肠道的症状来评估肠道损伤的程度。本研究的目的是根据WHO标准评估通透性变化是否与肠道毒性的临床评估相关，并检查高剂量化疗后肠道通透性的持续时间。在连续18例接受骨髓移植的患者中，在细胞毒性治疗开始前和干细胞输注后4、7、10和14天，通过Cr-51-EDTA吸收试验评估胃肠道通透性。在另外7名患者中，在细胞毒性治疗开始后2天以及干细胞输注后1、7和14天评估渗透性。在同一时期，根据WHO标准记录了口服和非口服临床毒性。与治疗前的渗透性相比，细胞毒性治疗开始后2天（P <0.05）、干细胞输注后第1天（P <0.05）、第4天（P <0.0005）、第7天（P < 0.0005）和第10天（P < 0.005）的渗透性显著增加。尽管存在显著的屏障功能障碍，但在早期移植过程中临床毒性非常温和。与无临床毒性或不需要治疗的毒性相比，胃肠道（而非口服）需要治疗的临床毒性与渗透性显著增加一致。同样，累积的胃肠道毒性，而不是口服毒性与渗透性的增加呈正相关。渗透性试验不能预测临床胃肠道毒性的严重程度。
The intensive cytotoxic treatment given in connection with bone marrow transplantations induces severe injury to the gut consistent with an increase in intestinal permeability. Currently, extent of the gut injury is assessed by inspecting the mouth and recording symptoms deriving from the gastro-intestinal tract. The aims of this study were to evaluate whether changes in permeability correlate with clinical assessment of gut toxicity, according to the WHO criteria, and also to examine the duration of intestinal permeability after high-dose chemotherapy. In 18 consecutive patients undergoing bone marrow transplantation, gastrointestinal permeability was assessed by a Cr-51-EDTA absorption test before the start of cytotoxic treatment, and 4, 7, 10 and 14 days after stem-cell infusion. In another seven patients, permeability was assessed 2 days after the start of cytotoxic treatment, and 1, 7 and 14 days after stem cell infusion. During the same period, oral- and non-oral clinical toxicity according to the WHO criteria were recorded. Permeability increased significantly 2 days after the start of cytotoxic treatment (P < 0.05), on day 1 (P < 0.05), on day 4 (P < 0.0005), on day 7 (P < 0.0005) and on day 10 (P < 0.005) after stem cell infusion, compared with pre-treatment permeability. Despite significant barrier dysfunction, clinical toxicity was very moderate in the early transplantation course. Gastro-intestinal, but not oral clinical toxicity requiring therapy, was consistent with a significant increase in permeability compared with no clinical toxicity or toxicity not requiring therapy. Similarly, cumulative gastro-intestinal, but not oral toxicity correlated positively with the increase in permeability. The permeability test was unable to predict the severity of the clinical gastro-intestinal toxicity.