土三七致肝窦阻塞综合征19例临床分析  

Hepatic sinusoidal obstruction syndrome related to Tusanqi： clinical analysis of 19 cases

作　　者：吴登科[1] 高杰[1] Wu Dengke;Gao Jie(Department of Pharmacy,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院药学部,215006

出　　处：《药物不良反应杂志》2018年第3期176-180,共5页Adverse Drug Reactions Journal

摘　　要：目的探讨土三七相关肝窦阻塞综合征（HSOS）的临床特征，以充分认识该病的严重性。 方法收集2011年1月至2018年5月苏州大学附属第一医院收治的土三七相关HSOS患者的病历资料进行回顾性分析。结果共19例患者纳入研究，包括男性12例（63.2%），女性7例（36.8%）；年龄44-82岁，中位年龄65岁。所有患者均误将土三七作为三七自行泡水（13例）、煎煮（4例）或泡酒（2例）服用。用药原因为外伤者11例，高血压病4例，腰椎间盘突出2例，腰椎骨折和前列腺炎出血各1例。用药时间为5-212 d，中位时间23 d。服用土三七至发生HSOS时间中位数为20（5-212）d。RUCAM评分为4、5、6、7、8分者分别为1、7、5、4、2例。肝脏储备功能Child-Pugh分级为A级者2例，B级8例，C级9例；肝损伤类型为胆汁淤积型5例，肝细胞损伤型6例，混合型8例。HSOS严重程度分级为超重度5例，重度4例，中度7例，轻度3例。临床表现以腹胀、纳差、黄疸、肝肿大、腹水和双下肢水肿等为主。实验室检查表现为ALT、AST、TBil、INR升高、凝血酶原时间延长和PLT、血清白蛋白降低。影像学表现主要为腹腔积液、肝肿大、肝实质密度减低、回声呈地图样不均匀强化、肝静脉显示不清。治疗措施采取保肝、利尿、抗凝、激素抗炎、改善微循环和血浆置换等。19例患者的结局：好转15例，死亡4例，病死率为21.1%。结论土三七相关的HSOS为一严重不良反应，以失代偿期肝病为主要表现，预后较差，病死率高。因此，应加强公众安全用药的教育，避免误用土三七。ObjectiveTo explore the clinical characteristics of hepatic sinusoidal obstruction syndrome （HSOS） related to Tusanqi （senecio chrysanthemoides） and fully recognize the severity of the disease.MethodsMedical record data of patients who were diagnosed as having Tusanqi-related HSOS in the First Affiliated Hospital of Soochow University from January 2011 to May 2018 were collected and analyzed retrospectively.ResultsA total of 19 patients entered the study, including 12 males （63.2%）, 7 females （36.8%）, and the median age was 65（44-82） years. All the patients mistook Tusanqi for Sanqi （Panax notoginseng）, and they themselves took Tusanqi steeping in water（13 cases）, decocting in water （4 cases） or soaking in wine（2 cases）. The reasons for taking Tusanqi were trauma（11 cases）, hypertension （4 cases of）, lumbar intervertebral disc herniation（2 cases）, lumbar fracture（1 cases）, and prostatitis hemorrhage（1 cases）. The median time of Tusanqi use was 23（5-212） days. The median time from Tusanqi initiation to onset of HSOS was 20 （5-212） days. The RUCAM score were 4 for 1 case, 5 for 7 cases, 6 for 5 cases, 7 for 4 cases, 8 for 2 cases. The patients′ Child-Pugh was classified as follows： A （2 cases）, B （8 cases） and C （9 cases）. The types of liver injury were cholestasis in 5 cases, hepatocyte injury in 6 cases, and mixed type in 8 cases. The severity of HSOS was classified as super severe in 5 cases, severe in 4 cases, moderate in 7 cases, and mild in 3 cases. The clinical manifestations included abdominal distension, poor appetite, jaundice, hepatomegaly, ascites, and edema of both lower limbs. Laboratory abnormalities included elevated ALT, AST, TBil, and INR levels, prolonged prothrombin time, and decreased PLT and serum albumin levels. The imaging findings were mainly ascites, hepatomegaly, decreased density of liver parenchyma, uneven liver enhancemen, and unclear hepatic vein. The treatment measures included hepatoprotection, diuresis,

关 键 词：吡咯里西啶生物碱 肝静脉阻塞病 药物性肝损伤 

分 类 号：R575[医药卫生—消化系统]