Endoscopic findings predict the histologic diagnosis in gastrointestinal graft-versus-host disease
Endoscopic findings predict the histologic diagnosis in gastrointestinal graft-versus-host disease
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DOI：
10.1055/s-2002-34257
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发表时间：
2002-10-01
期刊：
影响因子：
9.3
通讯作者：
Lee, LA
中科院分区：
文献类型：
--
作者：
Cruz-Correa, M;Poonawala, A;Lee, LA
背景和研究目的：胃肠道移植物抗宿主病（GvHD）是同种异体骨髓移植（BMT）术后发病和死亡的主要原因。内镜检查结果是否能预测胃肠道GvHD的组织学诊断仍有争议。我们进行了一项研究，以确定宏观内窥镜检查结果在诊断急性和慢性组织学证实的胃肠道GvHD （GI-GvHD）中的诊断准确性。患者和方法：对bmt后患者的肠黏膜内镜图像进行GI-GvHD的盲目分级，并与相应的组织学结果进行比较，作为金标准。结果：44例BMT患者接受了96次内镜检查。通过162对内镜-活检，观察到内镜分级与GI-GvHD的组织学分级呈正相关（比值比[OR] = 11.97, 95% Cl 3.86, 37.16）。内镜诊断正确预测急性和慢性GI-GvHD的组织学诊断（OR= 9.3 vs. 23.1， P= 0.31）。结论：内镜对急性和慢性组织学证实的GI-GvHD的诊断准确性都很高。GI-GvHD的准确诊断可以通过上或下胃肠道粘膜活检获得。内镜检查对BMT后GI-GvHD患者的早期诊断和治疗可能有重要作用，但最终诊断需要胃肠道黏膜的组织学评估。
Background and Study Aims: Graft-versus-host disease (GvHD) of the gastrointestinal tract is a major cause of morbidity and mortality after allogeneic bone marrow transplantation (BMT). Whether endoscopic findings predict the histologic diagnosis of GvHD in the gastrointestinal tract remains controversial. We performed a study to determine the diagnostic accuracy of macroscopic endoscopy findings in the diagnosis of acute and chronic histologically proven gastrointestinal GvHD (GI-GvHD).Patients and Methods: Endoscopic images from the intestinal mucosa of post-BMT patients were blindly graded as positive or negative for GI-GvHD and compared with corresponding histological findings, which were used as the gold standard.Results: 44 BMT patients were referred for 96 endoscopic eval uations. Using 162 endoscopy-biopsy pairs, a positive association between endoscopic grading and histologic grading of GI-GvHD (odds ratio [OR] = 11.97, 95 % Cl 3.86, 37.16) was observed. Endoscopic diagnosis correctly predicted histologic diagnosis in both acute and chronic GI-GvHD (OR= 9.3 vs. 23.1, P= 0.31).Conclusions: The diagnostic accuracy of endoscopy was high in both acute and chronic histologically proven GI-GvHD. Accurate diagnosis of GI-GvHD might be obtained with mucosal biopsies from either the upper or lower gastrointestinal tract. Endoscopy may play a significant role in establishing early diagnosis and treatment for GI-GvHD in patients following BMT, but histologic evaluation of the gastrointestinal mucosa is needed to confirm the final diagnosis.