土三七致肝小静脉闭塞病25例临床特点分析
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摘要
目的分析土三七致肝小静脉闭塞病的临床特点、治疗及预后。方法回顾性分析25例服用土三七致肝小静脉闭塞病患者临床资料,并对康复组与死亡组患者实验室检查结果进行比较。结果 20例患者在服药后3个月出现临床症状。临床表现主要为腹胀、腹水、肝大、黄疸等。实验室检查主要为肝功能异常、凝血酶原时间延长、血小板下降等。死亡组白细胞计数、凝血酶原时间、尿素氮水平较康复组明显升高(P<0.05)。彩超可见肝大、腹水、肝内"豹纹状"或"斑片状"低回声区等。增强CT可见特征性的"地图状"、"斑片状"强化。出院随访,死亡率约50%。结论服土三七药物患者白细胞计数升高、凝血酶原时间延长、尿素氮水平升高提示预后不良。目前无特效治疗,病死率较高。
Objective To investigate the clinical characteristics and prognosis of hepatic veno-occlusive disease(HVOD)induced by gynura segetum. Methods Clinical data of 25 gynura segetum-induced HVOD patients was retrospectively analyzed,and the comparison between rehabilitation group and death group were carried out.Results After taking gynura segetum for 3 months,20 patients(80%)had clinical symptoms and signs such as abdominal distension,ascites,hepatomegaly and jaundice.Laboratory tests also indicated abnormal liver function,prolonged prothrombin time(PT)and decreased platelet count.In death group,levels of white blood cell(WBC),PT and blood urea nitrogen(BUN)were significantly higher than those in rehabilitation group(P<0.05).Image examination showed hepatomegaly,ascites and "leopard" or "patchy" low echo area in color doppler ultrasound,and characteristic " map" or "patchy" enhancement in enhanced computed tomography(CT).The mortality was about 50% during the follow-up.Conclusion Definite medication history,clinical manifestations,laboratory tests and imaging examinations can help diagnose gynura segetum-induced HVOD.Elevated WBC count,prolonged PT,and elevated BUN levels may be indicators for poor prognosis.To date,there is no specific treatment for HVOD and the mortality is high.
Objective To investigate the clinical characteristics and prognosis of hepatic veno-occlusive disease(HVOD)induced by gynura segetum. Methods Clinical data of 25 gynura segetum-induced HVOD patients was retrospectively analyzed,and the comparison between rehabilitation group and death group were carried out.Results After taking gynura segetum for 3 months,20 patients(80%)had clinical symptoms and signs such as abdominal distension,ascites,hepatomegaly and jaundice.Laboratory tests also indicated abnormal liver function,prolonged prothrombin time(PT)and decreased platelet count.In death group,levels of white blood cell(WBC),PT and blood urea nitrogen(BUN)were significantly higher than those in rehabilitation group(P<0.05).Image examination showed hepatomegaly,ascites and "leopard" or "patchy" low echo area in color doppler ultrasound,and characteristic " map" or "patchy" enhancement in enhanced computed tomography(CT).The mortality was about 50% during the follow-up.Conclusion Definite medication history,clinical manifestations,laboratory tests and imaging examinations can help diagnose gynura segetum-induced HVOD.Elevated WBC count,prolonged PT,and elevated BUN levels may be indicators for poor prognosis.To date,there is no specific treatment for HVOD and the mortality is high.
引文
[1]Yu XZ,Ji T,Bai XL,et al.Expression of MMP-9in hepatic sinusoidal obstruction syndrome induced by Gynura segetum.J Zhejiang Univ Sci B,2013,14:68-75.
[2]Fu PP,Churchwell M,Wang Y,et al.High-performanced liquid chromatography electrospray ionization tandem mass spectrometry for the detection and quantitation of pyrrolizidine alkaloid-derived DNA adducts in vitro and in vivo.Chem Res Toxico,2010,23:637-652.
[3]Wang X,Qi X,Guo X.Tusanqi-Related Sinusoidal Obstruction Syndrome in China:A Systematic Review of the Literatures.Medicine,2015,94:e942.
[4]顾超,邹晓平,徐肇敏,等.土三七致肝小静脉闭塞病的临床特点分析.中华消化杂志,2010,30:771-772.
[5]方军伟,张国华,滕显木,等.土三七致肝小静脉闭塞大鼠模型中血液系统毒性和血管内皮分泌功能的观察研究.中华肝脏病杂志,2015,23:59-63.
[6]王强,鲁重美,温小恒.肝小静脉闭塞病.临床消化病杂志,2006,18:379-382.
[7]Pet j J,Pitk nen S,Vettenranta K,et al.Serum tumor marker CA 125 is an early and sensitive indicator of veno-occlusive disease in children undergoing bone marrow transplantation.Clin Cancer Res,2000,6:531-535.
[8]陈华忠,邵辉,耿才正,等.肝脏影像学检查在土三七引起的肝小静脉闭塞性疾病中的诊断价值.临床肝胆病杂志,2012,5:376-379.
[9]Richardson PG,Murakami C,Jin Z,et al.Multi-institutional use of defibrotide in 88 patients after stem cell transplantation with severe veno-occlusive disease and multisystem organ failure:response without significant toxicity in a high-risk population and factors predictive of outcome.Blood,2002,100:4337-4343.
[10]Fan CQ,Crawford JM.Sinusoidal obstruction syndrome(hepatic veno-occlusive disease).J Clin Exp Hepatol,2014,4:332-346.
[2]Fu PP,Churchwell M,Wang Y,et al.High-performanced liquid chromatography electrospray ionization tandem mass spectrometry for the detection and quantitation of pyrrolizidine alkaloid-derived DNA adducts in vitro and in vivo.Chem Res Toxico,2010,23:637-652.
[3]Wang X,Qi X,Guo X.Tusanqi-Related Sinusoidal Obstruction Syndrome in China:A Systematic Review of the Literatures.Medicine,2015,94:e942.
[4]顾超,邹晓平,徐肇敏,等.土三七致肝小静脉闭塞病的临床特点分析.中华消化杂志,2010,30:771-772.
[5]方军伟,张国华,滕显木,等.土三七致肝小静脉闭塞大鼠模型中血液系统毒性和血管内皮分泌功能的观察研究.中华肝脏病杂志,2015,23:59-63.
[6]王强,鲁重美,温小恒.肝小静脉闭塞病.临床消化病杂志,2006,18:379-382.
[7]Pet j J,Pitk nen S,Vettenranta K,et al.Serum tumor marker CA 125 is an early and sensitive indicator of veno-occlusive disease in children undergoing bone marrow transplantation.Clin Cancer Res,2000,6:531-535.
[8]陈华忠,邵辉,耿才正,等.肝脏影像学检查在土三七引起的肝小静脉闭塞性疾病中的诊断价值.临床肝胆病杂志,2012,5:376-379.
[9]Richardson PG,Murakami C,Jin Z,et al.Multi-institutional use of defibrotide in 88 patients after stem cell transplantation with severe veno-occlusive disease and multisystem organ failure:response without significant toxicity in a high-risk population and factors predictive of outcome.Blood,2002,100:4337-4343.
[10]Fan CQ,Crawford JM.Sinusoidal obstruction syndrome(hepatic veno-occlusive disease).J Clin Exp Hepatol,2014,4:332-346.