Beijing Youan Hospital, Capital Medical University, Beijing, China.
Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Medicine (Baltimore). 2023 Aug 11;102(32):e34698. doi: 10.1097/MD.0000000000034698.
Pyrrolizidine alkaloids induced hepatic sinusoidal obstruction syndrome (PA-HSOS) often occurs after consuming herbs or a dietary supplement containing the plant Tu-San-Qi. Limited data exists to identify patients with fatal outcomes for early interventions. We aimed to analyze the predictors for 3-month survival. We retrospectively enrolled PA-HSOS patients in 5 hospitals and extracted data from the onset of PA-HSOS to 36 months. Outcome measurements were 3-month and 36-month survival rates, baseline prognostic predictors for survival, and the effects of anticoagulant therapy. Among 49 enrollees, the median age was 60 and 49% male. At the onset of PA-HSOS, patients with Child-Turcotte-Pugh (CTP) class of A, B, or C were 8.2% (4/49), 42.8% (21/49) and 49.0% (24/49), respectively. None of them received a transjugular intrahepatic portosystemic shunt or a liver transplant. The 3-month and 36-month survival rates were 86% and 76%, respectively. Compared to the CTP class A or B, class C at baseline independently predicted lower survival rates at both 3 and 36 months. However, anticoagulation therapy treatment within the first 3 months independently predicted significantly higher survival rates at both time points. CTP class C and anticoagulant therapy were the independent predictors for short-term and long-term survival. Anticoagulant therapy could decrease mortality rate of CTP class C patients. The greatest benefit of anticoagulant evaluated by 3-month survival rate was in patients with CTP class C compared with those without treatment (93% vs 40%, P = .009). There were no bleeding complications reported in patients treated with the anticoagulant.
吡咯里西啶生物碱诱导的肝窦阻塞综合征（PA-HSOS）常发生在食用含有植物土三七的草药或膳食补充剂后。目前有限的数据可用于识别具有致命结局的患者，以便进行早期干预。我们旨在分析 3 个月生存率的预测因素。我们回顾性地纳入了 5 家医院的 PA-HSOS 患者，并从 PA-HSOS 发病到 36 个月提取数据。结果测量为 3 个月和 36 个月的生存率、生存的基线预后预测因素以及抗凝治疗的效果。在 49 名入组患者中，中位年龄为 60 岁，男性占 49%。在 PA-HSOS 发病时，Child-Turcotte-Pugh（CTP）分级为 A、B 或 C 的患者分别为 8.2%（4/49）、42.8%（21/49）和 49.0%（24/49）。他们都没有接受经颈静脉肝内门体分流术或肝移植。3 个月和 36 个月的生存率分别为 86%和 76%。与 CTP 分级 A 或 B 相比，基线时 CTP 分级 C 独立预测 3 个月和 36 个月时生存率较低。然而，在最初 3 个月内进行抗凝治疗独立预测在两个时间点均具有更高的生存率。CTP 分级 C 和抗凝治疗是短期和长期生存的独立预测因素。抗凝治疗可降低 CTP 分级 C 患者的死亡率。根据 3 个月生存率评估，抗凝治疗的最大获益是在 CTP 分级 C 的患者中，与未治疗的患者相比（93%对 40%，P =.009）。在接受抗凝治疗的患者中未报告出血并发症。
