简介:摘要目的通过对土三七所致肝小静脉闭塞病(HVOD)的临床表现、治疗方法、治疗效果进行总结分析,提高对本病的认识.方法检索2005年2月至2014年12月国内外报道的有关土三七所致HVOD的相关报道159例进行分析.结果本组病例均有明确服用土三七史;临床主要表现为腹水(90.34%),腹胀(73.58%),肝肿大(73.58%),黄疸(70.44%),腹痛(46.54%),伴有不同程度肝功能损害;CT检查主要表现为增强扫描见肝实质强化不均、呈“地图状”、“斑片状”;病理检查主要为肝窦淤血、扩张,肝实质细胞不同程度变性、坏死,小叶中央静脉或小叶下静脉内皮水肿、内膜肿胀、管腔狭窄;治愈/好转组与未愈/死亡组年龄、性别、服用时间及服用总量比较无显著区别,未愈/死亡组每天用量高于治愈/好转组(P<0.05).内科综合治疗加糖皮质激素治疗疗效优于单纯内科综合治疗,差异有统计学意义(P<0.05).结论土三七是导致HVOD的重要原因,详细询问服用药物史,结合临床表现、影像学及病理学检查有助诊断,内科综合治疗加糖皮质激素治疗可改善预后,临床医师应加强对HVOD的认识.关键词肝小静脉闭塞病;土三七;临床分析Clinicalfeaturesofhepaticveno-occlusivediseaseinducedBygynurarootanalysisof159casesZHANGRong-wen1,LENGAi-min2(1.DepartmentofDigestiveDisease,JinjiangHospital,Jinjiang362200;2.DepartmentofDigestiveDisease,XiangyaHospital,ZhongnanUniversty,Changsha410008)AbstractObjectiveToimprovetheunderstandingofthehepaticveno-occlusivedisease(HVOD)byanalyzingtheclinicalfeaturesandtreatmentofHVODcausedbygynuraroot.MethodsTheclinicaldataof159casesofHVODcausedbygynurarootreportedfromFebruary2005toDecember2014inChinaandabroadwasanalyzedretrospectively.Results159casesofHVODhadadefinitehistoryoftakinggynuraroot,Themainsymptomswereascites(90.34%),abdominaldisGtention(73.58%),hepatomegaly(73.58%),jaundice(70.44%)andabdominalpain(46.54%).Liverfunctionmaybeabnormal.Theimagingfeatureswerediffuseliverdamage,andthatcontrastagentaccumulatedunevenlyinparenchymaofliverinbothportalperiodandlagperiodbyCTcontrastenhancement.ThecharacGteristichistologicalchangesincludedhepaticcongestion,sinusoidaldilatation,hepatocytenecrosis,endothelialoedemaandnarrowingoflumenofcentrilobularveinorsublobularvein.Theoutcomesofagesandgenderandlastedtimeandthetotaldosearenodifferencebetweenimprovedpationsandnotimprovedpations,TheDailydosesofimprovedpationsismorethannotimprovedpations(P=0.047<0.05).Andtherewassignificanteffectinpatientswhoweretreatedwithmedicinecomprehensivetreatment(61.54%)comparedwiththosecomprehensivetreatmentbyapplyingglucocorticoidtreatment(86.36%)(P=0.035<0.05).ConclusionGynurarootisanimportantcauseofHVOD.AskfordetailsofhistoryofmedicationcombinwithliverbiopsyandimagingtestswasanefficientmethodforthediGagnosisofHVOD.Comprehensivetreatmentbyapplyingglucocorticoidtreatmentmaybevaluabletoimproveprognosis.CliniciansshouldraisetheHVODrecogGnitionK.eywordshepaticveno-occlusivedisease;gynuraroot;analysis中图分类号R575.1文献标识码A文章编号1008-6315(2015)12-0023-02