Definitive diagnosis of hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids

OBJECTIVE: Hepatic sinusoidal obstruction syndrome (HSOS) induced by a Chinese medicinal herb Tusanqi is increasingly being reported in recent years. The aim of the study was to investigate the possibility of using blood pyrrole‐protein adducts test as a confirmatory diagnostic method. METHODS: Patients with HSOS according to international diagnostic criteria associated with Tusanqi from January 2006 to August 2010 in Zhongshan Hospital Fudan University were included and clinical features were collected. Pyrrole‐protein adducts in blood sample were determined with ultra performance liquid chromatography‐mass spectrometry (UPLC‐MS) while pyrrolizidine alkaloids (PAs) in available herbal preparations were analyzed by high performance liquid chromatography‐ultraviolet (HPLC‐UV). RESULTS: Five patients (age 41–72 years, median age 54 years, all women) were included. Ascites (5/5), jaundice (5/5) and hepatomegaly (4/5) were common manifestations. The imaging features were diffused, patchy hepatic enhancement, periportal edema and ascites. Pathology ascertained that blood flow was obstructive at the site of sinusoid. PAs (Seneionine and seneciphylline) were identified in all the three available herbal preparations ingested by the HSOS patients. Pyrrole‐protein adducts were unequivocally found in all the five blood samples. Two patients recovered, two developed chronic illness and one died due to liver failure and hepatic encephalopathy. CONCLUSIONS: The detection of blood pyrrole‐protein adducts using a UPLC‐MS approach is a specific, reliable, unambiguous and confirmatory test for HSOS induced by PA, and should be used together with the conventional HSOS clinical diagnostic criteria for the definitive diagnosis of PA‐induced HSOS.     

土三七致肝窦阻塞综合征19例的影像及病理特征分析

目的:探讨土三七致肝窦阻塞综合征(HSOS)的CT、MRI表现及病理特征,旨在提高临床对该病的认识.方法:回顾性分析19例经病理证实的HSOS患者的影像资料及病理结果.结果:14例行CT平扫及增强扫描,示肝脏体积增大,密度不均匀,腹腔中重度积液;动脉期肝动脉增粗、扭曲,门静脉期及实质期肝实质呈斑片状不均匀强化,肝静脉三...     

土三七对食管癌细胞超微结构的影响

目的 研究土三七对食管癌细胞(Ec-109)超微结构的影响.方法 培养的Ec-109细胞分别与土三七提取液作用3,6 h后,通过透射电镜观察各实验组和对照组食管癌细胞的超微结构.结果 电镜下可见实验组Ec-109细胞出现粗面内质网消失,核糖体减少;线粒体呈空泡状,大部分嵴消失.药物对癌细胞的杀伤作用随时间延长而增强.结论 土三七对食管癌细胞超微结构有明显的破坏作用.