菊三七相关肝窦阻塞综合征临床结局相关影响因素分析  

Factors affecting the clinical outcomes of patients with gynura segetum induced sinusoidal obstruction syndrome

作　　者：邵幼林[1] 张锁才[1] 吴剑明[1] 谢静[1] 龙春梅[1] 郑婷婷[1] 柳龙根[1] SHAO You-lin;Zhang Suo-cai;Wu Jian-ming;XIE Jing;LONG Chun-mei;ZHENG Ting-ting;LIU Long-gen(Department of Hepatology,Changzhou Third People's Hospital,Jiangsu 213001,China)

机构地区：[1]常州市第三人民医院肝病科,江苏213001

出　　处：《肝脏》2021年第10期1170-1175,共6页Chinese Hepatology

基　　金：常州市应用基础研究计划项目(CJ20190080)。

摘　　要：目的探讨菊三七相关肝窦阻塞综合征(菊三七-HSOS)患者临床结局的相关影响因素。方法根据120天临床结局将患者分为存活组(37例)和死亡组(18例),比较两组患者服用菊三七等病史、入院时症状体征、检查项目、iMELD评分和治疗差异,采用Kalpan-meier生存曲线分析使用低分子肝素钠与患者120天预后的关系,采用Cox回归分析患者120天预后的影响因素,采用AUROC分析影响因素的预测效能。结果①患者服用菊三七日剂量和期限差别极大,两组患者主诉时长、服菊三七时长、服菊三七至发病的天数无统计学差异。②患者最主要症状包括乏力(96.36%)、食欲减退(96.36%)、腹胀(98.18%)、尿量减少(98.18%),两组间均无统计学差异。③死亡组血清TBil、DBil、TBA、WBC、Hb、INR、D-D二聚体和iMELD更高,CHOL更低。④采用Kalpan-meier生存曲线分析显示使用低分子肝素钠患者120天生存率更高,P=0.0061。⑤采用多因素Cox回归分析显示服菊三七时长、尿量减少、肝掌/蜘蛛痣、低分子肝素钠、CHOL、Hb和iMELD与患者临床结局相关。整合iMELD、Hb、CHOL、低分子肝素钠和肝掌/蜘蛛痣得出联合预测因子,其AUROC为0.91(95%CI:0.83~0.99)。结论使用低分子肝素钠治疗有利于提高菊三七-HSOS患者存活率,联合预测因子可以预测菊三七-HSOS 120天预后。Objective To investigate the factors affecting the clinical outcomes of patients with gynura segetum induced hepatic sinusoidal obstructive syndrome(gynura segetum-HSOS).Methods The patients were divided into survival group(n=37)and death group(n=18)according to the 120-day clinical outcomes.The medical history,clinical manifestations,laboratory examinations,iMELD scores and treatments were analyzed.Kalpan-meier survival curve was used to analyze the relationship between the use of low molecular weight heparin sodium and 120-day prognostic of gynura segetum-HSOS patients.Cox regression analysis was used to analyze the affecting factors of patients’120-day prognostic,and AUROC was used to analyze the predictive power of relevant factors.Results①The daily dose and durations of patients taking gynura segetum were with huge differences.There was no significant difference between both groups in the length of main complaint,the length of gynura segetum intake and the days from taking gynura segetum to onset.②The most common symptoms of patients with gynura segetum-HSOS were fatigue(96.36%),loss of appetite(96.36%),abdominal distension(98.18%),and reduced urine output(98.18%),and there was no statistical difference between the two groups.③In the death group,serum TBIL,DBIL,TBA,WBC,Hb,INR,D-D dimer levels and iMELD were significantly higher than those in the survival group,but CHOL was lower.④Kalpan-meier survival curve analysis showed patients treated with low molecular weight heparin sodium had a higher 120-day survival rate(P=0.0061).⑤The results of multivariate analyzed by Cox regression analysis revealed that reduced urine output,liver palm/spider angioma,low molecular weight heparin sodium,CHOL,Hb,iMELD were associated with clinical outcomes in patients with gynura segetum-HSOS.The AUROC of combined predictor which obtained based on the integration of iMELD,Hb,CHOL,low molecular weight heparin sodium and liver palm/spider angioma was 0.91(95%CI:0.83-0.99).Conclusion Application of low molecular weight h

关 键 词：菊三七 肝窦阻塞综合征 低分子肝素钠 临床结局 

分 类 号：R575[医药卫生—消化系统]