Objective: To investigate the prognostic value of enteroscopic grading for the prognostic assessment of patients with malignant hematological diseases who developed intestinal acute graft-versus-host disease (IT-aGVHD) after unrelated cord blood transplantation (UCBT) . Methods: Fifty patients with IT-aGVHD who developed hormone resistance after UCBT from June 2016 to June 2023 at Anhui Provincial Hospital were collected to compare the effective and survival rates of IT-aGVHD treatment in the group with milder enteroscopic mucosal injury (27 cases, enteroscopic grading of Ⅰ and Ⅱ) and the group with more severe injury (23 cases, enteroscopic grading of Ⅲ and Ⅳ) and to retrospectively analyze the factors affecting patients' prognosis. Results: Patients in the mild and severe groups had an effective rate of 92.6% and 47.8% at 28 days after colonoscopy (P<0.001), 81.5% and 39.1% at 56 days after colonoscopy (P=0.002), with optimal effective rate of 92.6% and 65.2% (P=0.040), respectively, and the differences were statistically significant. The multifactorial analysis found that enteroscopic grading was an independent risk factor affecting the effective rate of IT-aGVHD treatment. The overall survival rate at 2 years after colonoscopy was 70.4% (95% CI 52.0% -88.8% ) and 34.8% (95% CI 14.8% -54.8% ) for patients in the mild and severe groups, respectively, and the difference was statistically significant (P=0.003). Multifactorial analysis revealed that enteroscopic grading, cytomegalovirus infection status, second-line treatment regimen, and patients' age were independent risk factors for survival. Conclusion: The treatment efficacy and prognosis of patients in the group with less severe enteroscopic injury (grades Ⅰ and Ⅱ) were better than those in the group with more severe injury (grades Ⅲ and Ⅳ) .
目的： 探讨肠镜下分级对非血缘脐血移植（UCBT）后出现肠道急性移植物抗宿主病（IT-aGVHD）的恶性血液病患者的预后评估价值。 方法： 收集2016年6月至2023年6月在安徽省立医院进行UCBT后出现激素耐药的IT-aGVHD患者50例，比较肠镜下黏膜损伤较轻组（27例，肠镜下分级为Ⅰ、Ⅱ级）和较重组（23例，肠镜下分级为Ⅲ、Ⅳ级）患者IT-aGVHD治疗的有效率、生存率等，回顾性分析影响患者预后的因素。 结果： 轻症组、重症组患者在肠镜检查后28 d有效率分别为92.6%和47.8%（P<0.001），56 d有效率分别为81.5%和39.1%（P＝0.002），最优有效率分别为92.6%和65.2%（P＝0.040），差异均有统计学意义。多因素分析发现，肠镜下分级是影响IT-aGVHD治疗有效率的独立危险因素。轻症组、重症组患者肠镜检查后2年的总生存率分别为70.4%（95%CI 52.0%～88.8%）和34.8%（95%CI 14.8%～54.8%），差异有统计学意义（P＝0.003）。多因素分析显示，肠镜下分级、巨细胞病毒感染状态、二线治疗方案及患者的年龄是影响生存的独立危险因素。 结论： 肠镜下黏膜损伤程度较轻组（Ⅰ、Ⅱ级）患者的治疗有效率和预后优于损伤程度较重组（Ⅲ、Ⅳ级）。.
Keywords: Colonoscopy; Cord blood stem cell transplantation; Graft vs host disease.