急性GVHD（Graft-Versus-Host Disease）の腸病変の1例

Acute Intestinal Graft-Versus-Host Disease (GVHD), Report of a Case

要旨　GVHD（Graft-Versus-Host Disease）は骨髄移植後や大量輸血後に併発する皮疹，下痢，肝障害などの症状を中心とした疾患である．下痢の原因として以前より腸の炎症が指摘されていたが，その内視鏡所見についての論文はない．筆者らは29歳，男性で慢性骨髄性白血病で骨髄移植を受け，GVHDを併発し，下痢，下血を来したためコロノスコピーを施行，腸管GVHDの内視鏡像を観察し，第34回消化器内視鏡学会総会で報告した．筆者らが観察した腸管GVHDの大腸内視鏡所見は全結腸にわたる多発性のびらんで，そのびらんの形は地図状のもの，横軸方向に細長いもの，あるいはそれが癒合したものがみられた．その一部は出血性のびらんであった．びらんからの生検では，炎症に伴う，上皮基底層の空胞化による上皮の剥離が認められた．

　Colonoscopic observation was made on intestinal GVHD. The patient was 29-year-old male with myeloblastic leukemia which was diagnosed in 1981 and necessitated bone marrow transplantation on January 7, 1986. Eruption occurred 20 days later and biopsy of the skin led to the diagnosis of acute GVHD. Liver dysfunction and bloody diarrhea ensued 40 days later and colonoscopy and upper GI endoscopy were performed. Multiple erosions were found in the colon, terminal ileum and upper jejunum. Examination of the biopsy specimen from the upper jejunum showed denudation of the epithelium due to the vacuolated basal layer. The erosive lesions diappeared 90 days after the onset of bloody diarrhea.

　The patient, however, died of interstitial pneumonia on April 9, 1987.