土三七所致肝小静脉闭塞病102例临床分析

宋宇; 樊艳华

土三七所致肝小静脉闭塞病102例临床分析

宋宇,
樊艳华

中日友好医院消化科

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中图分类号: R595.3
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出版历程
- 出版日期: 2011-05-20

Clinical features of hepatic veno-occlusive disease induced by gynura root: analysis of 102 cases

Song Yu,
Fan YanHua

摘要

摘要: 目的总结分析土三七所致肝小静脉闭塞病(HVOD)的临床特点,提高对本病的认识。方法对1980年1月至2009年12月国内报道的土三七所致HVOD病例102例进行综合分析,并对国内外相关文献进行复习。结果患者土三七使用量150～5000 g(中位数500 g),服药时间4 d～1年(中位时间30 d),临床主要表现为腹胀(99.0%)、腹痛(69.6%)、肝大(93.5%)、腹水(97.7%)、黄疸(63.5%),有不同程度的肝功能受损。B超检查见肝静脉显示不清,肝段下腔静脉外形变细,但无明显栓塞物,彩色多普勒提示门脉血流减慢或逆向,增强CT示肝脏呈"地图状"强化不均匀。病理学表现为肝窦淤血、扩张,流出道受阻,肝细胞不同程度变性、坏死,小叶中央静脉内皮水肿或纤维增生。经内科治疗好转69.7%(62/89),未愈或死亡30.3%(27/89),另13例转归不详。使用抗凝或活血化瘀者有效率为81.0%,较未用者(47.8%),疗效差异有统计学意义(P=0.002)。结论土三七是导致HVOD的一个重要原因,影像和病理检查具有特征性,早期诊断及使用抗凝、活血治疗对改善预后有一定作用。
- 肝小静脉闭塞性疾病 /
- 土三七
Abstract: Objective To improve the understanding of the diagnosis and treatment of hepatic veno-occlusive disease (HVOD) by analyzing the clinical features of HVOD caused by gynura root.Methods The clinical data of 102 cases of HVOD caused by gynura root reported from January 1980 to December 2009 in China was analyzed retrospectivelyand the related literatures were reviewed.Results Gynura root was dosed from 150 g to 5000 g (median 500g) , lasted for over 4 days to 1 year (median 30 days) .The main symptoms were abdominal distention (99%) , abdominal pain (69.9%) , hepatomegaly (93.5%) , ascites (97.7%) and jaundice (63.5%) .Liver function may be abnormal.The imaging features were unclear hepatic vein, flat posterohepatic vena cava but no obstruction in it by type-B ultrasonography (US) , slow flow or reflux of portal vein by Doppler US and that contrast agent accumulated unevenly in parenchyma of liver in both portal period and lag period by CT contrast enhancement.The characteristic histological changes included hepatic congestion, sinusoidal dilatation, venous outflow occlusion, hepatocyte necrosis and endothelial oedema or fibrosis of centrilobular vein.After medical treatment, about 69.7% of 89 cases saw improvement, 30.3% of them didn't recover, and other 13 cases were unknown.And there was significant effect in patients who were treated with anticoagulant (81.0%) compared with those without anticoagulant (47.8%) (P=0.002) .Conclusion Gynura root is an important cause of HVOD.Early diagnosis and therapy with anticoagulant may be valuable to improve prognosis.
- hepatic veno-occlusive disease /
- gynura root

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