graft-versus-host disease
Introduction
Introduction to graft versus host disease Graft-versus-host disease (GVHD) is a systemic disease of multiple systemic damage (skin, esophagus, gastrointestinal, liver, etc.) that occurs after bone marrow transplantation (BMT) and is one of the leading causes of death. . Due to the immunological genetic differences between the recipients, the immunocompetent cells (mainly T lymphocytes) in the transplanted bone marrow recognize the different histocompatibility antigens of the receptor and proliferate and differentiate, and proliferate to a certain extent in the receptor. Later, some tissues or organs of the receptor are used as targets to carry out an immune attack to cause damage. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: erythema, splenomegaly, diarrhea
Cause
Graft-versus-host disease etiology
Cause (50%):
Graft-versus-host response is a specific immune phenomenon due to the reaction between immunocompetent cells in the graft tissue and tissues of immunosuppressed, tissue-incompatible antigen recipients.
Prevention
Graft versus host disease prevention
The prevention and treatment of GVHD is important to prevent, and to minimize the risk factors of GVHD is the most important measure. After transplantation, cyclosporine A, methotrexate, corticosteroids can reduce the incidence of GVHD, but also early The occurrence of GVHD and rash has a certain therapeutic effect. In recent years, new immunosuppressive drugs such as tacrolimus are being tested. In addition, anti-lymphocyte serum or anti-thymocyte globulin or serum is used for bone marrow transplant recipients. It has a certain preventive effect. When transfusion and blood products are used for immunodeficiency or immunosuppressed persons, blood or blood products should be irradiated with radiation before application.
Complication
Graft versus host disease complications Complications erythema spleen diarrhea
1. The earliest symptoms of aGVHD skin lesions include erythema, papules, blisters, and even skin exfoliation. In severe cases, skin lesions can spread to the whole body within a few days. The prominent manifestations of cGVHD lesions are hyperpigmentation, thickening of desquamation or keratosis. , mossy rash, etc., late skin hardening or joint contracture.
2. The liver is also the target organ of GVHD, aGVHD is more common, milder has no clinical symptoms, severe liver discomfort, splenomegaly, jaundice, etc., abnormal liver function is an important manifestation of GVHD, ALT, AKP, bilirubin, etc. There are different degrees of increase.
3. The oral mucosa may develop ulceration or exfoliation, and oral dryness may occur in the advanced stage.
4. When the peripheral blood picture recovered after BMT, nausea, vomiting, diarrhea and other symptoms unrelated to high-dose radiation and CTX pretreatment were manifestations of GVHD gastrointestinal mucosal damage.
Symptom
Graft-versus-host disease symptoms Common symptoms Nausea diarrhea Liver function abnormality Joint contracture jaundice
The most common symptoms are weight loss due to insufficient caloric intake due to dysphagia. Some patients experience severe pain during swallowing and unbearable chest pain. The causes of these symptoms include extensive epithelial esophagitis in the upper esophagus and upper esophagus. The formation of arachnoid thickening and mutual adhesion caused by esophageal stricture, abnormal esophageal peristalsis, dry mouth of the parotid gland, acid clearance became poor and reflux.
Examine
Graft-versus-host disease examination
Histopathological examination showed that there were a large number of lymphocytes and a small amount of plasma cells in epithelial detachment esophagitis, and neutrophils and eosinophils infiltrated the esophageal wall.
Endoscopy often has difficulty, can not show extensive exfoliation, extensive epithelial exfoliative esophagitis in the upper esophagus, arachnoid thickening formed in the upper esophagus and adhesion to each other, causing esophageal stenosis, abnormal esophageal motility.
Diagnosis
Diagnosis and differentiation of graft versus host disease
diagnosis
Diagnosis is based on clinical manifestations.
Differential diagnosis
1. Suppurative esophagitis: Suppurative esophagitis is the most common mechanical damage caused by foreign bodies. The bacteria multiply in the esophageal wall, causing local inflammatory exudation, different degrees of tissue necrosis and pus formation, and can also be more extensive. cellulitis.
2. Esophageal tuberculosis: Esophageal tuberculosis patients generally have other pioneer symptoms of tuberculosis, especially tuberculosis. The symptoms of esophagus are often confused or concealed by other organ symptoms, so that they cannot be discovered in time. According to the pathological process of tuberculosis, the early stage of infiltration can be advanced. There are symptoms of fatigue, low fever, increased erythrocyte sedimentation rate, but also symptoms are not obvious, followed by swallowing discomfort and progressive dysphagia, often accompanied by persistent throat and retrosternal pain, aggravation when swallowing, ulcer-type lesions Most of them are characterized by pain when swallowing. Food spilling into the trachea should consider the formation of tracheal esophageal fistula. Difficulty in swallowing suggests that the fibrosis of the lesion causes scarring.
3. Fungal esophagitis: the clinical symptoms of fungal esophagitis are atypical, some patients can have no clinical symptoms, common symptoms are swallowing pain, difficulty swallowing, upper abdominal discomfort, post-sternal pain and burning sensation, severe sternal rear It is like a knife-like colic, which can radiate to the back like angina. Candida esophagitis can cause severe bleeding but is not common. Untreated patients may have epithelial shedding, perforation or even disseminated candidiasis, and esophageal perforation can cause Mediastinal inflammation, esophageal tracheal fistula and esophageal stricture, patients with persistent high fever granulocytopenia should be checked for skin, liver, spleen, lung and other disseminated acute candidiasis.
4. Viral esophagitis: HSV infection of the esophagus often has nasal and herpes labia. The main symptom is swallowing pain. The pain is often aggravated when swallowing food. The patient's food is slow in the esophagus after swallowing. A few patients have difficulty swallowing. The main symptoms, mild infection can be asymptomatic.
