Identification of endoscopic factors that predict poor responses to steroids in patients with gastrointestinal acute graft-versus-host disease
Identification of endoscopic factors that predict poor responses to steroids in patients with gastrointestinal acute graft-versus-host disease
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预测胃肠道急性移植物抗宿主病患者对类固醇反应不佳的内镜因素的鉴定
DOI：
10.1038/s41409-020-01096-7
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发表时间：
2021
影响因子：
4.8
通讯作者：
O
中科院分区：
文献类型：
--
作者：
Morita Kaoru;Fujiwara Shin-ichiro;Ikeda Takashi;Kawaguchi Shin-ichiro;Toda Yumiko;Ito Shoko;Nagayama Takashi;Mashima Kiyomi;Umino Kento;Minakata Daisuke;Nakano Hirofumi;Yamasaki Ryoko;Ashizawa Masahiro;Yamamoto Chihiro;Hatano Kaoru;Sato Kazuya;Oh Iekuni;O
胃肠道急性移植物抗宿主病（aGVHD）是危及生命的并发症，需要紧急和适当的治疗。内镜检查被认为是诊断胃肠道aGVHD的金标准。然而，内窥镜检查的预后价值仍有争议。本研究旨在探讨治疗前上、下内窥镜检查的宏观和组织病理学结果对预测类固醇抵抗性胃肠道aGVHD的有用性。本回顾性研究纳入了44例胃肠道aGVHD患者，他们在诊断时接受了内窥镜检查，并在我院接受了全身类固醇治疗。我们使用先前验证的4分制对宏观和组织病理学结果进行分级。内镜分级的单变量分析显示，回肠的宏观分级越高，回肠和结肠的组织病理学分级越高，预示着对全身性类固醇的反应越差。在一项多变量分析中，宏观和组织病理学的严重程度在回肠被确定为重要的预后因素，表明类固醇治疗耐药。肉芽组织的存在也是对类固醇治疗耐药的一个强有力的独立预测因子。这些发现表明，回肠的宏观和组织病理学结果可能是类固醇难治性胃肠道aGVHD的有用预测指标，并可能表明立即需要开发二线策略。
Gastrointestinal acute graft-versus-host disease (aGVHD) is a life-threatening complication that requires urgent and appropriate treatment. An endoscopic examination is considered the gold-standard for the diagnosis of gastrointestinal aGVHD. However, the prognostic value of endoscopy remains controversial. This study aimed to investigate the usefulness of pre-treatment macroscopic and histopathologic findings of upper and lower endoscopy with respect to predicting steroid-resistant gastrointestinal aGVHD. This retrospective study included 44 patients with gastrointestinal aGVHD who underwent endoscopy at the time of diagnosis and received systemic steroid treatment at our hospital. We graded the macroscopic and histopathologic findings using a previously validated 4-point scale. Univariate analyses of endoscopic grading revealed that a higher macroscopic grade in the ileum and higher histopathologic grades in the ileum and colon predicted a poor response to systemic steroids. In a multivariate analysis, macroscopic and histopathologic severity in the ileum were identified as significant prognostic factors that indicated resistance to steroid therapy. The presence of granulation tissue was also a strong independent predictor of resistance to steroid therapy. These findings suggest that both macroscopic and histopathologic findings in the ileum may be useful predictors of steroid-refractory gastrointestinal aGVHD and can indicate an immediate need to develop a second-line strategy.
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回肠末端绒毛萎缩是同种异体造血干细胞移植后急性移植物抗宿主病的特殊内镜发现，与组织学证据和不良预后相关
影响因子：
2.4
作者：
Yuusaku Sugihara;S. Hiraoka;N. Fujii;S. Takashima;Y. Yamasaki;T. Inokuchi;M. Takahara;K. Kuwaki;K. Harada;Takehiro Tanaka;H. Okada
通讯作者：
H. Okada
影响因子：
20.3
作者：
Levine, John E.;Huber, Elisabeth;Holler, Ernst
通讯作者：
Holler, Ernst
影响因子：
9.3
作者：
Cruz-Correa, M;Poonawala, A;Lee, LA
通讯作者：
Lee, LA
DOI：
10.1016/j.bbmt.2017.05.017
发表时间：
2017-09
期刊：
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
影响因子：
--
作者：
Myerson D;Steinbach G;Gooley TA;Shulman HM
通讯作者：
Shulman HM
影响因子：
20.3
作者：
Daneshpouy, M;Socie, G;Janin, A
通讯作者：
Janin, A