| Background and ObjectiveHepatic sinus obstruction syndrome(HSOS)is a clinical syndrome characterized by Hepatomegaly,ascites,weight gain and jaundice.HSOS induced by hematopoietic stem cell transplantation is reported abroad.In developing countries,HSOS is mainly found in edible plants or foods containing pyrrolidine alkaloids(PAs).In recent years,more and more reports on HSOS caused by PAs-containing herbs such as gynura segetum have been reported in China.Because the clinical manifestations of HSOS are not specific,there are controversial treatment options,which are easy to be misdiagnosed and mistreated.This study retrospectively analyzed the clinical data of 98 patients with HSOS caused by Gynura Segetum,analyzed the clinical characteristics of hepatic sinus obstruction syndrome caused by Gynura Segetum,and explored the related factors of poor prognosis of the disease.Methods98 patients with HSOS related to Gynura Segetum admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to July 2018 were enrolled in the study.According to the follow-up results at 6 months,the patients were divided into two groups: the group with good prognosis(n=66)and the group with poor prognosis(n=32).The general data,clinical manifestations,laboratory results,imaging manifestations,therapy and prognosis of the two groups were compared Results1.General data: The average age of 98 patients with HSOS related to Gynura Segetum was(61.2 ±13.0)years old,ranging from 13 to 81 years old.The male-to-female ratio was 1.45:1.The average age of onset of HSOS was higher in males than in females.The age of the group with poor prognosis was older(age over 60 years old)and the male ratio was higher than that of the group with good prognosis.2.Etiology and previous history:All patients had a history of taking Gynura Segetum.The average time of taking Soil Notoginseng was 67.3 ±135.5)days.The average duration of symptoms before admission was 58.8 ±89.2days.There were 22 cases of hypertension,12 cases of type 2 diabetes mellitus,10 cases of old cerebral infarction,8 cases of coronary heart disease,1 case of varicose veins of lower limbs,1 case of rheumatoid arthritis,1 case of nephrotic syndrome and 1 case of ulcerative colitis.The proportion of cerebral infarction in poor prognosis group was higher than that in good prognosis group.3.Clinical manifestations:The main clinical manifestation of the patients were abdominal distension,jaundice,right upper abdominal pain,weight change,A few manifested oliguria,hematemesis and hepatic encephalopathy.The proportion of jaundice and hepatic encephalopathy in the poor prognosis group was higher than that in the good prognosis group.4.Laboratory examination: The results showed abnormal liver function and coagulation function,elevated CA125 and leaky ascites.Creatinine,alanine aminotransferase,glutamic oxalate aminotransferase,total bilirubin,direct bilirubin,prothrombin time,D-dimer and APRI were higher in the poor prognosis group than those in the good prognosis group,and prothrombin activity was lower than that in the good prognosis group.5.Imaging examination: The detection rate of color Doppler ultrasonography was 64.3%.The results showed ascites,hepatic vein stenosis or slowing down,hepatomegaly,portal vein slowing down or reversing.The detection rate of CT was 94.4%.The results showed ascites,uneven enhancement,hepatic vein slenderness.The liver stiffness of 10 patients was measured by ultrasound.The average value was(33.8 ±11.3)kpa,which was higher than the normal value.There were differences in ascites degree,portal vein velocity less than 10 cm or reverse proportion between the two groups.6.pathological examination: Pathological manifestations were focal,focal or patchy necrosis of hepatocytes,dilatation of hepatic sinuses,predominantly in area III of hepatic acini,perisinusoidal fibrosis,fibrosis around venules or portal areas,accompanied by chronic inflammatory cells7.Treatment: 73 cases were treated with medical treatment,25 cases with TIPS after medical treatment,66 cases were cured or improved,32 cases worsened.8.Prognosis: Follow-up for 1-70 months showed that the 1-month survival rate was 93.9%,the 6-month survival rate was 73.5%,the 1-year survival rate was 71.3%,and the 5-year survival rate was 65.2%.Multivariate analysis showed that the elderly(age over 60 years)and hepatic encephalopathy were independent risk factors for poor prognosis Conclusions1.Taking Gynura Segetum can cause hepatic sinus obstruction syndrome,and avoiding Gynura Segetum is the key to prevent hepatic sinus obstruction syndrome.2.The manifestations of HSOS patients caused by Gynura Segetum are not specific.Most of them can make early clinical diagnosis combined with medication history,clinical manifestations and uneven enhanced typical imaging.Pathological biopsy is feasible for highly suspected atypical cases.Some patients can recover after symptomatic and anticoagulant treatment,Invalid patients can choose TIPS operation according to their condition.3.Univariate analysis showed: advanced age(age ? 60 years),male,creatinine,ALT,AST,TBiL,DBil,PT,D dimer,APRI,ascites,portal flow less than 10 cm or reflux,hepatic encephalopathy and prognosis Adversely related,multivariate analysis showed that advanced age(age ? 60 years)and hepatic encephalopathy were independent risk factors for poor prognosis. |
PDF Full Text Request