Hepatic sinusoidal obstruction syndrome related to Tusanqi:clinical analysis of 19 cases
10.3760/cma.j.issn.1008-5734.2018.03.004
- VernacularTitle:土三七致肝窦阻塞综合征19例临床分析
- Author:
Dengke WU
1
;
Jie GAO
1
Author Information
1. 215006,苏州大学附属第一医院药学部
- Publication Type:Journal Article
- Keywords:
Pyrrolizidine alkaloids;
Hepatic veno-occlusive disease;
Drug-induced liver injury
- From:
Adverse Drug Reactions Journal
2018;20(3):176-180
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the clinical characteristics of hepatic sinusoidal obstruction syndrome (HSOS)related to Tusanqi (senecio chrysanthemoides)and fully recognize the severity of the disease. Methods Medical record data of patients who were diagnosed as having Tusanqi-related HSOS in the First Affiliated Hospital of Soochow University from January 2011 to May 2018 were collected and analyzed retrospectively. Results A total of 19 patients entered the study, including 12 males (63.2% ),7 females (36.8% ),and the median age was 65 (44-82 )years. All the patients mistook Tusanqi for Sanqi (Panax notoginseng),and they themselves took Tusanqi steeping in water(13 cases), decocting in water (4 cases)or soaking in wine(2 cases). The reasons for taking Tusanqi were trauma (11 cases),hypertension (4 cases of),lumbar intervertebral disc herniation(2 cases),lumbar fracture (1 cases),and prostatitis hemorrhage(1 cases). The median time of Tusanqi use was 23(5-212)days. The median time from Tusanqi initiation to onset of HSOS was 20 (5-212)days. The RUCAM score were 4 for 1 case,5 for 7 cases,6 for 5 cases,7 for 4 cases,8 for 2 cases. The patients′Child-Pugh was classified as follows:A (2 cases),B (8 cases)and C (9 cases). The types of liver injury were cholestasis in 5 cases,hepatocyte injury in 6 cases,and mixed type in 8 cases. The severity of HSOS was classified as super severe in 5 cases,severe in 4 cases,moderate in 7 cases,and mild in 3 cases. The clinical manifestations included abdominal distension,poor appetite,jaundice,hepatomegaly,ascites,and edema of both lower limbs. Laboratory abnormalities included elevated ALT,AST,TBil,and INR levels,prolonged prothrombin time,and decreased PLT and serum albumin levels. The imaging findings were mainly ascites, hepatomegaly,decreased density of liver parenchyma,uneven liver enhancemen,and unclear hepatic vein. The treatment measures included hepatoprotection,diuresis,anticoagulation,hormone therapy,improvement of microcirculation and plasmapheresis. The outcomes of the patients showed that 15 patients improved,and 4 died;and the mortality was 21.1%. Conclusions Tusanqi-related HSOS was a serious adverse reaction with decompensated liver disease as the main manifestation,poor prognosis and high mortality. Therefore, public education of safe drug use should be strengthen to avoid the misuse of Tusanqi.
