Endoscopic Evaluation in Gastrointestinal Graft-Versus-Host Disease: Comparisons with Histological Findings
Endoscopic Evaluation in Gastrointestinal Graft-Versus-Host Disease: Comparisons with Histological Findings
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DOI：
10.1007/s10620-008-0262-6
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发表时间：
2008-11-01
影响因子：
3.1
通讯作者：
Kang, Chang Suk
中科院分区：
文献类型：
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作者：
Cheung, Dae Young;Kim, Jin Il;Kang, Chang Suk
胃肠道是移植物抗宿主病（GVHD）的主要靶点。内镜检查结果是否可以预测GVHD的组织学诊断和严重程度仍然存在争议。我们研究了内窥镜检查与组织学检查之间的相关性，并评估了内窥镜检查对GVHD治疗临床决策的影响。本研究为回顾性单中心研究。101例接受同种异体造血干细胞移植（HSCT）并有GI GVHD风险的患者接受内镜评估。以盲法检查内镜图像和组织学以诊断和分级，并将组织学结果作为诊断的“金标准”。内镜检查结果显示与GVHD组织学异常有显著正相关（优势比[OR] = 33.6, 95% CI 4.3-261.1），敏感性和特异性分别为98和44%。内镜和组织学分级的kappa系数为0.423 （p值< 0.001）。在57例组织学阴性病例中，有10例（18%）患者在内镜检查中被成功诊断为GVHD。虽然内镜诊断GVHD的总体可靠性在敏感性和特异性方面仍然不足，但3级或4级等高级别病例的内镜表现与组织学表现有明显的一致性。当组织学与临床表现不一致时，内镜检查可以提供关键信息并对临床决策产生关键影响。
The gastrointestinal (GI) tract is the major target site of the graft-versus-host disease (GVHD). Whether endoscopic findings can predict the histological diagnosis and degree of severity in GVHD remains controversial. We investigated the degree of correlation between endoscopic and histological findings, and evaluated the impact of endoscopic examination on clinical decision in GVHD management. This study was conducted as a retrospective single-center study. One hundred and one patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and at the risk of GI GVHD were referred for endoscopic evaluation. Endoscopic images and histology were reviewed to diagnose and grade in a blind fashion, and the histological findings were used as the "gold standard" for diagnosis. Endoscopic findings revealed a significantly positive association with histological abnormalities of GVHD (odds ratio [OR] = 33.6, 95% CI 4.3-261.1), and the sensitivity and specificity were 98 and 44%, respectively. The kappa coefficient for agreement between the endoscopic and histological grading was 0.423 (p-value < 0.001). Ten (18%) patients out of 57 histology-negative cases were managed successfully as GVHD on the endoscopic finding. Though the overall reliability of endoscopic diagnosis in GVHD is still insufficient in terms of sensitivity and specificity, high-grade cases such as grades 3 or 4 showed specific endoscopic findings to draw a significant agreement with histological findings. Endoscopic examination can give critical information and impose a pivotal impact on clinical decision when the histology is discordant with clinical presentation.