Villous atrophy in the terminal ileum is a specific endoscopic finding correlated with histological evidence and poor prognosis in acute graft-versus-host disease after allo-hematopoietic stem cell transplantation
Villous atrophy in the terminal ileum is a specific endoscopic finding correlated with histological evidence and poor prognosis in acute graft-versus-host disease after allo-hematopoietic stem cell transplantation
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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
作者：
Yuusaku Sugihara;S. Hiraoka;N. Fujii;S. Takashima;Y. Yamasaki;T. Inokuchi;M. Takahara;K. Kuwaki;K. Harada;Takehiro Tanaka;H. Okada
移植物抗宿主病(GVHD)是异基因造血干细胞移植(allo-HSCT)的常见并发症。内窥镜活检可以提供明确的诊断，但诊断的最佳内窥镜方法仍不确定。本研究旨在探讨回肠结肠镜检查能否预测allo-HSCT后急性移植物抗宿主病(GVHD)的严重程度。方法选择接受allo-HSCT的患者为研究对象，并将病理诊断为急性移植物抗宿主病的患者纳入本研究。我们通过逐步变量选择进行了单因素和多因素条件Logistic回归分析：回肠末端绒毛萎缩仍然是移植物抗宿主病严重程度的显著预测因素(优势比，4.69；95%可信区间，1.07-20.60，P = 0.04)。根据回肠末端回肠内窥镜检查结果，将患者分为三组：S组，移植物抗宿主病伴重度绒毛萎缩；M组，轻度萎缩；N组，无萎缩。与M组和N组相比，S组在确诊时临床移植物抗宿主病的发生率显著高于M组和N组(P = 0.03)。与M组和N组13例患者中的5例相比，S组4例中有3例需要加用二线药物(P = 0.02)。结论本研究显示回肠末端严重萎缩预示着严重的临床移植物抗宿主病，这可能是激素治疗无效的。因此，末端回肠萎缩的严重程度可以作为预测临床严重GVHD的工具。试验注册号UMIN 000022805，注册日期2016年7月1日。
BackgroundGraft-versus-host disease (GVHD) is a common complication of allo-hematopoietic stem cell transplantation (allo-HSCT). Endoscopic biopsy can provide a definitive diagnosis, but the optimal endoscopic approach for diagnosis remains uncertain. This study evaluated whether ileocolonoscopic imaging can predict acute GVHD severity after allo-HSCT.MethodsConsecutive patients who underwent allo-HSCT were referred to our institution, and those diagnosed with acute GVHD by pathology were included in this retrospective study.ResultsFifty-one of 261 patients who underwent ileocolonoscopy were suspected to have acute intestinal GVHD. We performed univariate and multivariate conditional logistic regression with stepwise variable selection; villous atrophy in the terminal ileum remained a statistically significant predictor of GVHD severity (odds ratio, 4.69; 95% confidence interval, 1.07–20.60, P = 0.04). Patients were classified into three groups based on ileal endoscopic findings in the terminal ileum: group S, GVHD with severe villous atrophy; group M, mild atrophy; and group N, no atrophy. Compared with patients in groups M and N, those in group S had significant clinical GVHD at diagnosis (P = 0.03). In group S, three of four, compared with five of 13 patients in groups M and N, required the addition of second-line agents (P = 0.02).ConclusionsThis study showed that severe atrophy of the terminal ileum predicts severe clinical GVHD that is likely to be refractory to steroid treatment. Thus, the severity of terminal ileum atrophy may serve as a tool in predicting clinically severe GVHD.Trial registrationTrial Registration Number UMIN 000022805, Registration date July 1, 2016.
影响因子：
29.4
作者：
COX, GJ;MATSUI, SM;MCDONALD, GB
通讯作者：
MCDONALD, GB