Oral manifestations of acute and chronic GVHD (graft-versus-host disease) after allogeneic bone marrow transplantation : Histochemical examination of lip biopsies

通常认为同种异体骨髓移植（allogeneic bone marrow transplantation， BMT）后GVHD早期出现口腔表现，通过唇活检进行口腔检查对慢性GVHD具有预测价值，早期识别口腔慢性GVHD可及时诊断，提高BMT受者的生存率。观察口腔急性和慢性GVHD的临床表现，比较唇组织化学特征。GVHD患者CD4、CD8淋巴细胞浸润于粘膜下、上唾液腺区，角质形成细胞、粘膜下、上唾液腺HLA-DR、ICAM-1阳性。我们提出了口腔黏膜炎的一些宏观表现，并试图建立口腔慢性GVHD的检查标准。我们称之为“慢性GVHD口炎”，即白色增厚、苔藓样病变、毛细血管扩张样病变、溃疡形成、坏死、瘢痕形成、粘膜萎缩伴口干。

It is commonly refered that oral manifestations appear in the early stage of GVHD after allogeneic bone marrow transplantation (BMT), and the oral examination by lip biopsies has the predictive value of chronic GVHD, and the early recognition of oral chronic GVHD may lead to timely diagnosis resulting improved survival rate of BMT recipients. We observed the clinical appearance of oral acute and chronic GVHD, comparing the histochemical features of lip biopsies. In the GVHD cases, CD4 and CD8 lymphocytes were infiltrated into submucous and meiner salivary gland region, and the keratinocytes, submucous regions and meiner salivary glands were HLA-DR and ICAM-1 positive. We presented some macroscopic patterns of oral mucositis, and tried to make the criteria of inspection of oral chronic GVHD.We called the status as "chronic GVHD stomatitis", i.e. white thickening, licheniod lesion, teleangiectasia like lesion, ulcer formation, necrosis, scar formation and atrophy of mucosa with xerostomia.