移植物對抗宿主疾病：修订间差异

移植物對抗宿主疾病; Graft-versus-host disease
类型	移植排斥、免疫系统疾病[*]
病因	Graft vs Host Reaction[*]
分类和外部资源
醫學專科	急診醫學
ICD-11	4B24
ICD-10	T86.0
ICD-9-CM	279.50
OMIM	614395
DiseasesDB	5388
MedlinePlus	001309
eMedicine	429037、886758、1050580
Orphanet	39812
	[编辑此条目的维基数据]

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2023年12月7日 (四) 14:07的版本

移植物對抗宿主疾病（Graft-versus-host disease）簡稱GvHD，是在移植來自其他人身上的組織及器官（英语：allotransplantation）後產生的併發症。GvHD一般和骨髓移植有關，但此概念也可以用在其他組織的的移植上。GvHD是移植物中的免疫細胞（白血球）將宿主視為異物，因此攻擊宿主細胞的行為。若輸血的血液製品未經適當處理，輸血後也可能出現GvHD的情形。

移植物對抗宿主疾病和移植排斥不同，移植排斥是宿主排斥移植物，而移植物對抗宿主疾病是移植物排斥宿主，兩者的基本原理都是同種異體免疫（英语：alloimmunity），不過其細節可能會有些不同。

移植物對抗宿主疾病也可能出現在輸血後，若血品未經過伽马射线或其他核可的白血球降低系統處理，就可能會有此疾病，稱為輸血相關移植物抗宿主疾病（TA-GvHD）。TA-GvHD和器官或組織移植造成的移植物對抗宿主疾病不同，TA-GvHD的發生率和HLA符合的程度成正相關^[1]。

Types

在臨床上，移植物對抗宿主疾病可以分為急性和慢性，根據受影響的組織以及反應的嚴重性來評分^[3]^[4]

傳統的觀點，急性移植物對抗宿主疾病的特點是肝臟、皮膚（皮疹）、黏膜或消化道的選擇性破壞。較新的研究指出其他移植物對抗宿主疾病針對的器官包括免疫系統（造血系統，也就是骨髓及胸腺），以及肺（例如免疫介導的肺炎）^[5]。生物標誌物可以用來識別GvHD的特殊原因，例如皮膚上的elafin（英语：elafin）^[6]。慢毞的移植物對抗宿主疾病也會攻擊上述器官，不過其長期的影響也會破壞结缔组织及外分泌腺^[7]。

陰道的黏膜受損也可能會造成劇痛、疤痕，以及急性或慢性的GvHD，可能會因此導致無法進行性行為^[8]。

參考資料

^ Williamson, Lorna M. Transfusion associated graft versus host disease and its prevention. Heart. 1998-09-01, 80 (3): 211–212. ISSN 1355-6037. PMC 1761088 . PMID 9875072. doi:10.1136/hrt.80.3.211 （英语）.
^ Ghimire S, Weber D, Mavin E, Wang XN, Dickinson AM, Holler E. Pathophysiology of GvHD and Other HSCT-Related Major Complications. Frontiers in Immunology. 2017, 8: 79. PMC 5357769 . PMID 28373870. doi:10.3389/fimmu.2017.00079 .
^ Martino R, Romero P, Subirá M, Bellido M, Altés A, Sureda A, et al. Comparison of the classic Glucksberg criteria and the IBMTR Severity Index for grading acute graft-versus-host disease following HLA-identical sibling stem cell transplantation. International Bone Marrow Transplant Registry. Bone Marrow Transplantation. August 1999, 24 (3): 283–7. PMID 10455367. S2CID 24811357. doi:10.1038/sj.bmt.1701899 .
^ Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biology of Blood and Marrow Transplantation. December 2005, 11 (12): 945–56. PMC 4329079 . PMID 16338616. doi:10.1016/j.bbmt.2005.09.004.
^ Morisse-Pradier H, Nove-Josserand R, Philit F, Senechal A, Berger F, Callet-Bauchu E, et al. [Graft-versus-host disease, a rare complication of lung transplantation]. Revue de Pneumologie Clinique. February 2016, 72 (1): 101–7. PMID 26209034. doi:10.1016/j.pneumo.2015.05.004.
^ Paczesny S, Braun TM, Levine JE, Hogan J, Crawford J, Coffing B, et al. Elafin is a biomarker of graft-versus-host disease of the skin. Science Translational Medicine. January 2010, 2 (13): 13–14. PMC 2895410 . PMID 20371463. doi:10.1016/j.bbmt.2008.12.039.
^ Ogawa Y, Shimmura S, Dogru M, Tsubota K. Immune processes and pathogenic fibrosis in ocular chronic graft-versus-host disease and clinical manifestations after allogeneic hematopoietic stem cell transplantation. Cornea. November 2010,. 29 Suppl 1 (Nov Supplement 1): S68–77. PMID 20935546. S2CID 39209313. doi:10.1097/ICO.0b013e3181ea9a6b.
^ Spiryda LB, Laufer MR, Soiffer RJ, Antin JA. Graft-versus-host disease of the vulva and/or vagina: diagnosis and treatment. Biology of Blood and Marrow Transplantation. December 2003, 9 (12): 760–5. PMID 14677115. doi:10.1016/j.bbmt.2003.08.001 .

外部链接

[1] Williamson, Lorna M. Transfusion associated graft versus host disease and its prevention. Heart. 1998-09-01, 80 (3): 211–212. ISSN 1355-6037. PMC 1761088 . PMID 9875072. doi:10.1136/hrt.80.3.211 （英语）.

[2] Ghimire S, Weber D, Mavin E, Wang XN, Dickinson AM, Holler E. Pathophysiology of GvHD and Other HSCT-Related Major Complications. Frontiers in Immunology. 2017, 8: 79. PMC 5357769 . PMID 28373870. doi:10.3389/fimmu.2017.00079 .

[Martino_et_al_1999-3] Martino R, Romero P, Subirá M, Bellido M, Altés A, Sureda A, et al. Comparison of the classic Glucksberg criteria and the IBMTR Severity Index for grading acute graft-versus-host disease following HLA-identical sibling stem cell transplantation. International Bone Marrow Transplant Registry. Bone Marrow Transplantation. August 1999, 24 (3): 283–7. PMID 10455367. S2CID 24811357. doi:10.1038/sj.bmt.1701899 .

[pmid16338616-4] Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biology of Blood and Marrow Transplantation. December 2005, 11 (12): 945–56. PMC 4329079 . PMID 16338616. doi:10.1016/j.bbmt.2005.09.004.

[Morisse-Pradier_et_al_2016-5] Morisse-Pradier H, Nove-Josserand R, Philit F, Senechal A, Berger F, Callet-Bauchu E, et al. [Graft-versus-host disease, a rare complication of lung transplantation]. Revue de Pneumologie Clinique. February 2016, 72 (1): 101–7. PMID 26209034. doi:10.1016/j.pneumo.2015.05.004.

[Paczesny_et_al_2009-6] Paczesny S, Braun TM, Levine JE, Hogan J, Crawford J, Coffing B, et al. Elafin is a biomarker of graft-versus-host disease of the skin. Science Translational Medicine. January 2010, 2 (13): 13–14. PMC 2895410 . PMID 20371463. doi:10.1016/j.bbmt.2008.12.039.

[Ogawa_et_al_2010-7] Ogawa Y, Shimmura S, Dogru M, Tsubota K. Immune processes and pathogenic fibrosis in ocular chronic graft-versus-host disease and clinical manifestations after allogeneic hematopoietic stem cell transplantation. Cornea. November 2010,. 29 Suppl 1 (Nov Supplement 1): S68–77. PMID 20935546. S2CID 39209313. doi:10.1097/ICO.0b013e3181ea9a6b.

[Spiryda_et_al_2003-8] Spiryda LB, Laufer MR, Soiffer RJ, Antin JA. Graft-versus-host disease of the vulva and/or vagina: diagnosis and treatment. Biology of Blood and Marrow Transplantation. December 2003, 9 (12): 760–5. PMID 14677115. doi:10.1016/j.bbmt.2003.08.001 .

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 移植物對抗宿主疾病也可能出現在[[輸血]]後，若[[血品]]未經過[[伽马射线]]或其他核可的[[白血球]]降低系統處理，就可能會有此疾病，稱為[[輸血相關移植物抗宿主疾病]]（TA-GvHD）。TA-GvHD和器官或組織移植造成的移植物對抗宿主疾病不同，TA-GvHD的發生率和HLA符合的程度成正相關<ref>{{Cite journal |last=Williamson |first=Lorna M. |date=1998-09-01 |title=Transfusion associated graft versus host disease and its prevention |url=https://heart.bmj.com/content/80/3/211 |journal=Heart |language=en |volume=80 |issue=3 |pages=211–212 |doi=10.1136/hrt.80.3.211 |issn=1355-6037 |pmid=9875072|pmc=1761088 }}</ref>。
+==Types==
+[[File:Micrographs of grades of skin graft-versus-host-disease.jpg|thumb|不同等級植皮對抗宿主疾病顯微照片：第一級是在表皮中有小型空泡化、第二級是有空泡化及角化不良小體、第三級是有表皮下裂隙形成，第四級則是表皮和真皮分離<ref>{{cite journal | vauthors = Ghimire S, Weber D, Mavin E, Wang XN, Dickinson AM, Holler E | title = Pathophysiology of GvHD and Other HSCT-Related Major Complications | journal = Frontiers in Immunology | volume = 8 | pages = 79 | year = 2017 | pmid = 28373870 | pmc = 5357769 | doi = 10.3389/fimmu.2017.00079 | doi-access = free }}</ref>]]
+在臨床上，移植物對抗宿主疾病可以分為急性和慢性，根據受影響的組織以及反應的嚴重性來評分<ref name="Martino et al 1999">{{cite journal | vauthors = Martino R, Romero P, Subirá M, Bellido M, Altés A, Sureda A, Brunet S, Badell I, Cubells J, Sierra J | display-authors = 6 | title = Comparison of the classic Glucksberg criteria and the IBMTR Severity Index for grading acute graft-versus-host disease following HLA-identical sibling stem cell transplantation. International Bone Marrow Transplant Registry | journal = Bone Marrow Transplantation | volume = 24 | issue = 3 | pages = 283–7 | date = August 1999 | pmid = 10455367 | doi = 10.1038/sj.bmt.1701899 | s2cid = 24811357 | doi-access = free }}</ref><ref name="pmid16338616">{{cite journal | vauthors = Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, Martin P, Chien J, Przepiorka D, Couriel D, Cowen EW, Dinndorf P, Farrell A, Hartzman R, Henslee-Downey J, Jacobsohn D, McDonald G, Mittleman B, Rizzo JD, Robinson M, Schubert M, Schultz K, Shulman H, Turner M, Vogelsang G, Flowers ME | display-authors = 6 | title = National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report | journal = Biology of Blood and Marrow Transplantation | volume = 11 | issue = 12 | pages = 945–56 | date = December 2005 | pmid = 16338616 | pmc = 4329079 | doi = 10.1016/j.bbmt.2005.09.004 | url = http://www.bbmt.org/article/S1083-8791(05)00631-2/abstract }}</ref>
+傳統的觀點，急性移植物對抗宿主疾病的特點是[[肝臟]]、[[皮膚]]（皮疹）、[[黏膜]]或[[消化道]]的選擇性破壞。較新的研究指出其他移植物對抗宿主疾病針對的器官包括免疫系統（[[造血作用|造血系統]]，也就是[[骨髓]]及[[胸腺]]），以及[[肺]]（例如免疫介導的[[肺炎]]）<ref name="Morisse-Pradier et al 2016">{{cite journal|display-authors=6|vauthors=Morisse-Pradier H, Nove-Josserand R, Philit F, Senechal A, Berger F, Callet-Bauchu E, Traverse-Glehen A, Maury JM, Grima R, Tronc F, Mornex JF|date=February 2016|title=[Graft-versus-host disease, a rare complication of lung transplantation]|journal=Revue de Pneumologie Clinique|volume=72|issue=1|pages=101–7|doi=10.1016/j.pneumo.2015.05.004|pmid=26209034}}</ref>。生物標誌物可以用來識別GvHD的特殊原因，例如皮膚上的{{le|elafin|elafin}}<ref name="Paczesny et al 2009">{{cite journal|display-authors=6|vauthors=Paczesny S, Braun TM, Levine JE, Hogan J, Crawford J, Coffing B, Olsen S, Choi SW, Wang H, Faca V, Pitteri S, Zhang Q, Chin A, Kitko C, Mineishi S, Yanik G, Peres E, Hanauer D, Wang Y, Reddy P, Hanash S, Ferrara JL|date=January 2010|title=Elafin is a biomarker of graft-versus-host disease of the skin|journal=Science Translational Medicine|volume=2|issue=13|pages=13–14|doi=10.1016/j.bbmt.2008.12.039|pmc=2895410|pmid=20371463}}</ref>。慢毞的移植物對抗宿主疾病也會攻擊上述器官，不過其長期的影響也會破壞[[结缔组织]]及[[外分泌腺]]<ref name="Ogawa et al 2010">{{cite journal|vauthors=Ogawa Y, Shimmura S, Dogru M, Tsubota K|date=November 2010|title=Immune processes and pathogenic fibrosis in ocular chronic graft-versus-host disease and clinical manifestations after allogeneic hematopoietic stem cell transplantation|journal=Cornea|volume=29 Suppl 1|issue=Nov Supplement 1|pages=S68-77|doi=10.1097/ICO.0b013e3181ea9a6b|pmid=20935546|s2cid=39209313}}</ref>。
+[[陰道]]的黏膜受損也可能會造成劇痛、[[疤痕]]，以及急性或慢性的GvHD，可能會因此導致無法進行[[性交|性行為]]<ref name="Spiryda et al 2003">{{cite journal|vauthors=Spiryda LB, Laufer MR, Soiffer RJ, Antin JA|date=December 2003|title=Graft-versus-host disease of the vulva and/or vagina: diagnosis and treatment|journal=Biology of Blood and Marrow Transplantation|volume=9|issue=12|pages=760–5|doi=10.1016/j.bbmt.2003.08.001|pmid=14677115|doi-access=free}}</ref>。
 ==相關條目==
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 {{过敏及自身免疫疾病}}
-{{醫學小作品}}
 [[Category:免疫系统疾病]]