Value of skin biopsies in assessing prognosis and progression of acute graft-versus-host disease
Value of skin biopsies in assessing prognosis and progression of acute graft-versus-host disease
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DOI：
10.1097/00000478-199709000-00002
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发表时间：
1997-09-01
影响因子：
5.6
通讯作者：
Smoller, BR
中科院分区：
文献类型：
--
作者：
Kohler, S;Hendrickson, MR;Smoller, BR
皮肤活检通常在异基因骨髓移植（BMT）后进行，以帮助确定移植受体中新皮疹的起源。皮肤急性移植物抗宿主反应的组织学标准和分级系统已经很好地建立。然而，组织学诊断可能很困难，并且是基于对细微变化的解释，这些变化与其他实体中观察到的特征有显著重叠，这些特征可能是移植后皮疹的原因，如药物反应，病毒性皮疹和化疗的影响。我们回顾性分析了137例接受同种异体BMT的患者的179例皮肤活检。我们比较了71例急性移植物抗宿主病（GvHD）患者的98例皮肤活检和66例接受活检以排除GvHD但没有继续发展为临床疾病的患者的81例活检。两名观察员在不了解临床情况的情况下审查了每张载玻片，并对16个组织学参数进行了分级。没有单一参数（例如，角化不良的角质形成细胞、基底空泡化、卫星样增生、附件中的坏死细胞）在单变量分析中达到统计学显著性。使用逻辑回归搜索将GvHD活检与非GvHD活检分开的因素未能揭示单个最佳预测因子或预测因子的组合。我们的结论是，皮肤活检后异基因骨髓移植是有限的使用预测皮疹的进展，临床II级或更高的GVHD。
Skin biopsies are commonly performed after allogeneic bone marrow transplantation (BMT) to help establish the origin of a new skin rash in a transplant recipient, Histologic criteria and a grading system for acute graft-versus-host reaction of the skin are well established. Histologic diagnosis, however, can be difficult and is based on interpretation of subtle changes that show significant overlap with features seen in other entities that can be responsible for a skin rash in the posttransplantation period such as drug reactions, viral exanthems, and the effects of chemotherapy, We retrospectively reviewed 179 skin biopsies from 137 patients who had under one allogeneic BMT. We compared 98 skin biopsies from 71 patients with acute graft-versus-host disease (GvHD) with 81 biopsies from 66 patients who underwent biopsy to exclude GvHD but did not go on to develop the disease on clinical grounds. Two observers reviewed each slide without knowledge of the clinical situation and graded 16 histologic parameters. No single parameter (e.g., dyskeratotic keratinocytes, basal vacuolization, satellitosis, necrotic cells in appendages) achieved statistical significance on univariate analysis. A search for factors to separate GvHD biopsies from non-GvHD biopsies using logistic regression failed to reveal a single best predictor or a combination of predictors. We conclude that skin biopsies after allogeneic BMT are of limited use in predicting the progression of a skin rash to clinical grade II or higher GVHD.