Wang Yan, Qiao Dan, Li Ya, Xu Feng
Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Donglu, Zhengzhou, 450052, Henan, China.
Department of Zhengzhou Center for Disease Control and Prevention, Zhengzhou, China.
BMC Gastroenterol. 2018 Oct 26;18(1):156. doi: 10.1186/s12876-018-0879-7.
Hepatic veno-occlusive disease (HVOD) caused by Gynura segetum has been increasingly reported in China in recent years. The aim of this retrospective study was to identify independent prognostic markers for survival in patients with Gynura segetum-induced HVOD and to evaluate the effect of anticoagulants and transjugular intrahepatic portosystemic shunt (TIPS) on survival rate.
Clinical data including symptoms, signs, imaging characteristics, laboratory test results, results of liver tissue biopsies, type of treatment during follow-up and clinical outcomes were collected. Univariate, multivariate and time-dependent Cox regression analyses were performed.
Survival rates were 91% (95% confidence interval [CI], 82-95%), 64% (95% CI, 53-69%) and 57% (95% CI, 51-65%) at 1, 3 and 60 months, respectively. Total bilirubin, albumin and hepatic encephalopathy were independent prognostic markers of survival. Anticoagulants were administered to 76% of the patients. Among 75 patients treated with anticoagulants, 49 patients (65.3%) were cured, whereas 26 patients (34.7%) died; the cure rate in anticoagulant-treated patients was higher than that of those not treated with anticoagulants (χ = 9.129, P = 0.004). Cure rate of the anticoagulation + TIPS treatment group was 64.3%, which was also higher than that of the non-anticoagulation group; however, this was not significantly different (χ = 3.938, P = 0.096).
The presence of hepatic encephalopathy, serum bilirubin and albumin levels were major prognostic factors for Gynura segetum-induced HVOD. Anticoagulation therapy significantly increased the cure rate; however, TIPS treatment did not have a beneficial effect on the cure rate.
近年来，中国由紫背天葵引起的肝静脉闭塞病（HVOD）报道日益增多。本回顾性研究旨在确定紫背天葵所致HVOD患者生存的独立预后标志物，并评估抗凝剂和经颈静脉肝内门体分流术（TIPS）对生存率的影响。
收集临床资料，包括症状、体征、影像学特征、实验室检查结果、肝组织活检结果、随访期间的治疗类型及临床结局。进行单因素、多因素和时间依赖性Cox回归分析。
1个月、3个月和60个月时的生存率分别为91%（95%置信区间[CI]，82 - 95%）、64%（95%CI，53 - 69%）和57%（95%CI，51 - 65%）。总胆红素、白蛋白和肝性脑病是生存的独立预后标志物。76%的患者接受了抗凝治疗。在75例接受抗凝治疗的患者中，49例（65.3%）治愈，而26例（34.7%）死亡；抗凝治疗患者的治愈率高于未接受抗凝治疗的患者（χ = 9.129，P = 0.004）。抗凝 + TIPS治疗组的治愈率为64.3%，也高于非抗凝组；然而，差异无统计学意义（χ = 3.938，P = 0.096）。
肝性脑病、血清胆红素和白蛋白水平是紫背天葵所致HVOD的主要预后因素。抗凝治疗显著提高了治愈率；然而，TIPS治疗对治愈率没有有益影响。
