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

一般认为，口腔表现出现于异基因骨髓移植（BMT）后GVHD的早期，唇活检口腔检查对慢性GVHD有预测价值，早期发现口腔慢性GVHD可及时诊断，提高BMT受者的生存率。观察口腔急、慢性移植物抗宿主病的临床表现，比较唇活检组织的组织化学特征。移植物抗宿主病患者口腔黏膜下及小涎腺区有CD 4、CD 8淋巴细胞浸润，口腔黏膜下及小涎腺区的角质形成细胞呈HLA-DR和ICAM-1阳性。本文介绍了口腔粘膜炎的几种肉眼表现，并试图建立口腔慢性GVHD的检查标准，将口腔粘膜白色增厚、苔藓样病变、毛细血管扩张样病变、溃疡形成、坏死、瘢痕形成、萎缩伴口腔干燥等称为“慢性GVHD口腔炎”。

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.