Clinical Analysis Of Hepatic Veno-occlusive Disease Induced By Gynura Root: One Case Report And Review Of The Literature

Purpose: Hepatic veno occlusive disease, also known as Sinusoidal obstruction syndrome, SOS), is stenosis or occlusive, mainly in hepatic vein terminal branch(diameter less than 300 um), central vein and sublobular vein, the main line branch is not easily affected. Hepatomegaly, ascites, jaundice are clinically as main performance; some patients may develop into liver cirrhosis. In the western developed countries, it often happens after Hematopoietic stem cell transplantation(HSCT), liver transplantation and chemotherapy. In China, it is mainly in the crowds who have history of taking plants or herbal medicines which contain pyrrolidine alkaloid. In recent years, domestic also have the related reports of the disease. Because of its onset conceals, lack of characteristic clinical manifestations, diagnosis need liver puncture and pathological biopsy, and there is no standardized treatment, so the case fatality rate is higher, has brought many difficult problems of diagnosis and treatment to the clinical doctors. This article, through to one case report and 37 cases of patients with HVOD clinical manifestation, laboratory examination, imaging examination and histopathology results and relevant treatment and prognosis, has a systematic analysis and research. Its purpose is to improve the clinical doctors’ understanding of the disease.Methods: At first, there is a case report with HVOD in our hospital. Then retrieving China National Knowledge Infrastructure and wanfang database in June 2009 to October 2014 domestic reports about HVOD, eliminating duplicate cases and 2 cases of children, and adding 1 case that our hospital receive, this article collects totally 37 cases with HVOD. Inclusion criteria: Patients who have been definitely diagnosed by clinical or pathology, have definite history of taking gynura before its onset. Exclusion criteria: the pathological results do not accord with HVOD; clinical information is unknown; with alcoholic liver disease, viral hepatitis liver disease, and autoimmune liver disease such as the basis.Result: The main symptoms of HVOD include ascites(94%), abdominal distension(92%), hepatomegaly(67%), uncomfortable of hepatic region(52%), etc., it can be associated with fever, fatigue, loss of appetite, etc., when it develop to late it can appear end-stage liver disease related complication and(or), multiple organ failure, severe cases can die. Laboratory examination of 37 patients were promoted to different degrees of abnormal liver function, such as aminotransferase elevation(AST/ALT>1, 84%), direct bilirubin elevation absorption of abnormal bilirubin, some patients can appear the performance of abnormal coagulant function such as PT extension, etc. Result of 86% patients’ ascites test tip transudate, there are 2 cases between transudate and exudate, all cases do not check out cancer cell. Serum tumor marks(AFP, CA19-9, and CEA) are all within the normal range except CA125 can increase. Imaging examination ultrasound hint of chronic diffuse liver damage, peritoneal effusion, including 2 cases with visible liver parenchyma echo, plate shaped reduce area. Abdominal enhanced CT can see liver parenchyma with asymmetry improved shadow at portal venous phase, a ‘map’(80%), and 60% of cases were observed that their hepatic vein become thin, narrow or no image. Upper abdominal MRI can also be observed performance similar to that of the abdominal CT. 25 patients accepted liver biopsy examination, pathological results can all see hepatic sinus congestion, expansion, accompanied by liver cell swelling, degeneration, liquefactive necrosis, and inflammatory cell infiltration based lymphocyte cell. Some patients may have central vein or sublobular vein intima proliferation and stenosis, 7 patients have manifestation of lumen fibrosis, and 1 case of them has had a sign of forming pseudolobule. 37 patients all accepted nutritional support and liver protection, diuretics therapy etc conventional treatment. On this basis, also including 22 patients received anticoagulation and(or) improve the microcirculation treatment, 18 cases were improved or cured, the remaining 4 cases, curative effect is poor. In the 15 cases without anticoagulation or improve microcirculation treatment, 7 cases got better and discharged from hospital, the other 8 cases treatment is invalid, removed from hospital or dead. Compare with the anticoagulants or improve circulation medicine group and the only available foundation treatment group with chi-square data. The difference was statistically significant.Conclusion: patients with the main symptoms as ascites, jaundice, hepatomegaly, with the past medicine history of gynura, need heightened alertness about the possibility of HVOD. The ‘map’symptom in the abdominal CT, MRI is of great significance in the diagnosis of portal venous phase. The liver pathological biopsy is the gold standard of diagnosis of the disease. If do not have the condition of the liver biopsy, it can be primary diagnosed combining with its gynura taking history, laboratory examination, imaging examination. On the treatment, using anticoagulation medicine and improve microcirculation treatment in the early stage on the basis of liver treatment can be result in good effects.