Dai Feng, Qiao Wei, Kang Zheng, Chen Yan, Li Kang, Shen Wenrong, Zhang Xiuming
Department of Interventional Radiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China.
Department of Radiology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Int J Gen Med. 2022 Mar 2;15:2389-2396. doi: 10.2147/IJGM.S348176. eCollection 2022.
This study aimed to analyze the clinical features and computed tomography (CT) manifestations of hepatic sinusoidal obstruction syndrome (HSOS) induced by Gynura segetum, a Chinese herbal medicine, so as to improve the clinical understanding and diagnosis of the disease.
Relevant clinical and laboratory parameters and CT imaging data of 20 patients with HSOS confirmed by liver biopsy were retrospectively analyzed and compared with 16 patients with Budd-Chiari syndrome (BCS).
Levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and glutamyl transpeptidase increased significantly (p < 0.05) in HSOS patients compared to the BCS patients, while the albumin level and prothrombin time, which are indicators of liver synthesis function, decreased and prolonged significantly, respectively. All 20 patients with HSOS had manifestations of ascites and heterogeneous hypoattenuation on CT, including 18 cases (90%) with heterogeneous enhancement (characteristic map-like enhancement), 17 (85%) with hepatomegaly, 18 (90%) with gallbladder wall oedema, and 16 (80%) with stenosis of main hepatic veins and characteristic "clover-like" enhancement at the second porta hepatis.
Both HSOS and BCS are post-sinusoidal portal hypertension, but have different etiologies and durations. Although they both cause liver congestion, the clinical manifestation of HSOS is acute liver injury. The CT manifestations are characterized by ascites, map-like enhancement and heterogeneous hypoattenuation of the liver parenchyma, and stenosis of the main hepatic veins. BCS is often found in the stage of decompensated liver cirrhosis, resulting in liver shrinkage, splenomegaly, and ascites.
本研究旨在分析中药紫背天葵所致肝窦阻塞综合征（HSOS）的临床特征及计算机断层扫描（CT）表现，以提高对该疾病的临床认识和诊断水平。
回顾性分析经肝活检确诊的20例HSOS患者的相关临床和实验室参数及CT影像资料，并与16例布加综合征（BCS）患者进行比较。
与BCS患者相比，HSOS患者的丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶和谷氨酰转肽酶水平显著升高（p < 0.05），而作为肝脏合成功能指标的白蛋白水平和凝血酶原时间分别显著降低和延长。20例HSOS患者均有腹水及CT上肝脏实质不均匀低密度影的表现，其中18例（90%）有不均匀强化（特征性地图样强化），17例（85%）有肝脏肿大，18例（90%）有胆囊壁水肿，16例（80%）有肝主静脉狭窄及第二肝门处特征性“三叶草样”强化。
HSOS和BCS均为肝窦后性门静脉高压，但病因和病程不同。虽然二者均导致肝脏淤血，但HSOS的临床表现为急性肝损伤。其CT表现以腹水、肝脏实质地图样强化及不均匀低密度影、肝主静脉狭窄为特征。BCS常出现在肝硬化失代偿期，导致肝脏萎缩、脾肿大和腹水。
