Division of Hemato-Oncology, Department of Internal Medicine, Chang-Gung Memorial Hospital and Chang-Gung University College of Medicine, Taoyuan, Taiwan, R.O.C.
Division of Chinese Acupuncture and Traumatology, Department of Traditional Chinese Medicine, Chang-Gung Memorial Hospital and Chang-Gung University College of Medicine, Taoyuan, Taiwan, R.O.C.
In Vivo. 2019 Sep-Oct;33(5):1697-1702. doi: 10.21873/invivo.11658.
BACKGROUND/AIM: Chemotherapy is often halted due to abnormal liver function resembling hepatitis. But the cause can be extrahepatic portal venous obstruction (EHPVO) with hepatic enzyme elevation rather than being an adverse effect of chemotherapy. We investigated EHPVO with hepatic enzyme elevation in patients with cancer.
Data of these hospitalized patients with solid tumors between January 2013 and September 2017 were collected. The criteria for study inclusion were: (i) Extrahepatic malignancy; (ii) computed tomographic scans showing a tumor with external compression of the extrahepatic portal vein; and (iii) serum aminotransferase (AST) or alanine transaminase (ALT) level three times above the normal value.
Thirteen out of 377 (3%) patients developed EHPVO with hepatic enzyme elevation, as demonstrated from computed tomographic scan. Four cases (31%) also had vascular thrombosis (three portal vein and one inferior vena cava). Serum AST increased from 34±11 to 169±94 U/l. ALT increased from 9±38 to 177±104 U/l. There was no relationship of EHPVO with viral markers and cirrhosis. Six cases received chemotherapy with liver function improvement.
EHPVO occurred in patients with metastatic cancer, leading to hepatic enzyme elevation resembling hepatitis without hepatitis risk factors and cirrhosis. Before withholding chemotherapy due to hepatic enzyme elevation, the possibility of EHPVO should firstly be excluded.
背景/目的：由于肝功能异常类似于肝炎，化疗经常会停止。但是，引起肝酶升高的原因可能是肝外门静脉阻塞（EHPVO），而不是化疗的不良反应。我们调查了癌症患者中伴有肝酶升高的 EHPVO。
收集了 2013 年 1 月至 2017 年 9 月期间住院的实体瘤患者的数据。纳入研究的标准为：（i）肝外恶性肿瘤；（ii）计算机断层扫描显示肿瘤对肝外门静脉有外部压迫；（iii）血清天冬氨酸氨基转移酶（AST）或丙氨酸氨基转移酶（ALT）水平高于正常值的三倍。
在 377 名患者中，有 13 名（3%）患者通过计算机断层扫描显示发生了伴有肝酶升高的 EHPVO。其中 4 例（31%）还存在血管血栓形成（3 例门静脉和 1 例下腔静脉）。血清 AST 从 34±11 增加到 169±94 U/l。ALT 从 9±38 增加到 177±104 U/l。EHPVO 与病毒标志物和肝硬化无关。6 例患者接受化疗后肝功能改善。
转移性癌症患者发生 EHPVO，导致肝酶升高类似于肝炎，但无肝炎危险因素和肝硬化。在因肝酶升高而停止化疗之前，应首先排除 EHPVO 的可能性。
