胃と腸40巻8号

2005年07月発行

今月の主題 免疫異常と消化管病変 主題

代表的な免疫異常状態における消化管病変の特徴―消化管GVHD

著者： 岩男泰¹ 矢島知治¹ 泉谷幹子¹ 松岡克善¹ 日比紀文² 森毅彦² 岡本真一郎³ 亀山香織³ 向井萬起男⁴

所属機関： ¹慶應義塾大学包括先進医療センター ²慶應義塾大学消化器内科 ³慶應義塾大学血液内科 ⁴慶應義塾大学病理診断部

ページ範囲：P.1172 - P.1184

要旨　内視鏡検査を施行した同種造血幹細胞移植症例155例を検討した．41例が病理組織学的にGVHDと確定診断され，うち12例は他臓器GVHDを伴わない消化管GVHDであった．上部消化管で31例，下部消化管で19例が診断された．上部消化管では胃，下部消化管では終末回腸・深部結腸での内視鏡的有所見率，GVHD診断率が高かった．内視鏡所見としては，粘膜浮腫，発赤，びらん，潰瘍などを認めた．炎症細胞浸潤をあまり伴わない間質浮腫を反映したびまん性の粘膜浮腫像が高率にみられ，比較的特徴的な所見と考えられた．上部消化管で17例，下部消化管で8例のCMV感染を認めた．うちGVHDを伴わないCMV感染例が6例あり，びまん性粘膜変化を伴わないdiscreteな病変が特徴であった．消化管GVHDの早期診断のみならず，日和見感染との鑑別においても，積極的な内視鏡検査の重要性が示唆された．

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