Tandon H D, Tandon B N, Mattocks A R
Am J Gastroenterol. 1978 Dec;70(6):607-13.
A large outbreak of veno-occlusive disease occurred in Afghanistan in which approximately 7,800 in a population of 35,000 subjects were estimated to have been affected. It was caused by consumption of wheat flour heavily contaminated with seeds of a plant of the heliotropium species. These were found to contain pyrrolizidine alkaloids, chiefly heliotrine. Fourteen percutaneous liver biopsies, representing different stages of diseases and liver tissue from eight autopsies were studied. Morphological changes in the liver were characteristic. Centrilobular hemorrhagic necrosis was followed by occlusive changes in the hepatic veins, finally resulting in nonportal cirrhosis. The sequence of changes observed suggests primary parenchymal injury and possibly obstructive lesions at the sinusoidal level. Collagenization of the sinusoids and reorganization of the lobular reticulin begin early in disease. Occlusive changes in the efferent veins apparently follow.
阿富汗发生了大规模的肝小静脉闭塞病疫情，估计在35000名受检者中有约7800人受到影响。这是由于食用了被天芥菜属植物种子严重污染的小麦粉所致。这些种子被发现含有吡咯里西啶生物碱，主要是天芥菜碱。对代表疾病不同阶段的14份经皮肝活检样本以及8例尸检的肝组织进行了研究。肝脏的形态学变化具有特征性。小叶中心出血性坏死之后是肝静脉的闭塞性改变，最终导致非门脉性肝硬化。观察到的变化顺序提示原发性实质损伤，可能还有窦状隙水平的阻塞性病变。疾病早期即出现窦状隙胶原化和小叶网状纤维重组。随后显然出现了输出静脉的闭塞性改变。
