ETIOLOGY AND OUTCOME OF DIARRHEA AFTER MARROW TRANSPLANTATION - A PROSPECTIVE-STUDY
ETIOLOGY AND OUTCOME OF DIARRHEA AFTER MARROW TRANSPLANTATION - A PROSPECTIVE-STUDY
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DOI：
10.1016/0016-5085(94)90542-8
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发表时间：
1994-11-01
期刊：
影响因子：
29.4
通讯作者：
MCDONALD, GB
中科院分区：
文献类型：
--
作者：
COX, GJ;MATSUI, SM;MCDONALD, GB
背景/目的：骨髓移植后的急性腹泻通常归因于急性移植物抗宿主病（GVHD）或感染，据报道感染发生率为 40%-50%。本研究的目的是确定移植后急性腹泻的发生率、其原因及其结果。方法：对296例患者进行随访；使用粪便标准评估和免疫电子显微镜对腹泻患者进行研究；星状病毒、小核糖核酸病毒和诺沃克病毒检测；以及产毒素大肠杆菌的基因探针方法。还对 38 名腹泻患者的肠活检标本和十二指肠液进行了分析。结果：126 名患者发生了 150 次急性腹泻（发生率为 43%）。 150例病例中有20例发现肠道感染：病毒（星状病毒、腺病毒、巨细胞病毒、轮状病毒）12例，院内获得性细菌（艰难梭菌、气单胞菌）7例，混合感染1例。 150 次发作中，有 72 次是由急性 GVHD 引起的（48%）。感染和GVHD的临床症状和体征相似。在 150 次发作中，有 58 次（39%）没有找到明确的自限性腹泻病因。结论：肠道感染占腹泻发作的 13%，急性 GVHD 占 48%。最常见的感染微生物是星状病毒、艰难梭菌和腺病毒。大多数骨髓移植后腹泻病例不是由感染引起的。
Background/Aims: Acute diarrhea after marrow transplant is usually ascribed to acute graft-vs.-host disease (GVHD) or infection, with a reported 40%-50% incidence of infection. The aim of this study was to determine the incidence of acute diarrhea after transplantation, its causes, and its outcome. Methods: Two hundred ninety-six patients were followed up; patients with diarrhea were studied using standard evaluation of stool plus immunoelectron microscopy; assays for astrovirus, picobirnavirus, and Norwalk virus; and gene-probe methods for toxin-producing Escherichia coli. In 38 patients with diarrhea, intestinal biopsy specimens and duodenal fluid were also analyzed. Results: One hundred fifty acute diarrheal episodes developed in 126 patients (an incidence of 43%). Intestinal infection was found in 20 of 150 episodes: viruses (astrovirus, adenovirus, cytomegalovirus, and rotavirus) in 12 patients, nosocomially acquired bacteria (Clostridium difficile and Aeromonas) in 7 patients, and mixed infection in 1 patient. Acute GVHD was responsible for 72 of 150 episodes (48%). Clinical signs and symptoms of infection and GVHD were similar. In 58 of 150 episodes (39%), no clear etiology could be found for self-limited diarrhea. Conclusions: Intestinal infection accounted for 13% and acute GVHD for 48% of diarrheal episodes. The most common infecting organisms were astrovirus, C. difficile, and adenovirus. Most cases of diarrhea after marrow transplant are not caused by infection.