Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China; Department of Geriatric Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China; Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
J Integr Med. 2020 Sep;18(5):434-440. doi: 10.1016/j.joim.2020.07.006. Epub 2020 Jul 30.
Hepatic veno-occlusive disease (HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.
This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.
Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen (P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived (both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels. Unexpectedly, we found that hydrothorax was detected in 21 (65.63%) patients in the death group and 19 (59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio (INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.
HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.
近年来，肝静脉阻塞性疾病（HVOD）因其与食用三叶鬼针草有关而受到越来越多的关注。由于缺乏特异性治疗方法，严重 HVOD 的死亡率仍然很高。本研究旨在描述 HVOD 的临床特征和结局，并探讨其潜在的预后因素。
这是一项单中心回顾性研究。2009 年 1 月至 2018 年 5 月，浙江大学第一附属医院从有三叶鬼针草摄入史的患者中筛选出 89 例 HVOD 患者，这些患者在出现症状前有服用史。根据截至 2019 年 9 月 1 日的临床随访结果，将纳入的患者分为存活组和死亡组。记录患者的人口统计学变量和临床数据。进行二项逻辑回归分析和受试者工作特征曲线，以确定预后因素并评估其对死亡预测的预后价值，并进行生存分析以评估临床结局。
64 例患者符合进一步分析的条件。大多数患者表现为腹胀，腹部移动性浊音阳性（P=0.740 和 P=0.732）。死亡组患者的终末期肝病模型评分较高，且凝血酶原时间高于存活组（均 P<0.001）。所有 HVOD 患者在生存组和死亡组均表现为腹水，肝脏实质和肝血管的影像学表现异常。出乎意料的是，我们发现，在死亡组的 21 例（65.63%）和存活组的 19 例（59.38%）患者中，在住院期间检测到胸腔积液，这在以前的研究中很少提及。此外，国际标准化比值（INR）和肌酐被发现是预测死亡的潜在独立预后因素。6 例重症患者在肝移植后临床改善并存活。
三叶鬼针草可引起 HVOD，INR 联合肌酐对预测死亡具有预后价值。肝移植可能是治疗严重 HVOD 患者的有效方法。
