提高对“土三七”致肝小静脉闭塞病的认识

我国肝小静脉闭塞病（HVOD）的病因多见于长期或过量服用土三七。土三七内舍有吡咯烷生物碱成分，可造成肝窦和肝小静脉的内皮细胞损伤．导致肝小静脉阻塞。HVOD所致的血流阻力部位为肝内，引起窦后性门静脉高压。肝大、右上腹痛、腹水和黄疸是其主要临床表现。诊断依据：有长期服用或过量服用土三七史；有上述临床表现；血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、1-谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）、胆红素（BiL）均增高；B超可见腹水、肝肿大、肝区呈“斑片状”低回声区，肝静脉显示不清或不显示；CT检查可见肝肿大、腹水，增强CT动脉期显示全肝密度不均匀，呈现“斑片状”或“地图状”改变。肝活检早期可见肝小静脉管腔狭窄，肝小静脉周围血管阻塞．肝细胞不同程度液化坏死．晚期可见纤维化。早期诊断和及时治疗有较好的预后。临床医师应提高对HVOD的认识．且要提醒人们不要滥用土三七。

Raise the Recognition of Hepatic Veno-occlusive Disease Induced by Chrysanthemum-like Groundsel

Hepatic veno-occlusive disease （HVOD） is usually caused by long-term or excessive intake of chrysanthemum-like groundsel. Chrysanthemum-like groundsel consists of pyrrolizidine alkaloids which can damage the hepatic sinusoids and venous endothelia resulting in HVOD. The postsinusoidal portal hypertension is due to the increased intrahepatie blood flow resistance. Hepatomegaly, right upper abdominal pain, ascites and jaundice are the main clinical manifestations of HVOD. The diagnosis is based on： history of long-term or excessive intake of large amount of chrysanthemium-like groundsel, the above-mentioned clinical manifestations, increase of serum alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, γ-glutamyltransferase （GGT）, alkaline phosphatase （ALP） and bilirubin. B mode Ultrasound indicates aseites, hepatomegaly, patchy hypoeehoic areas, invisible hepatic veins. CT shows hepatomegaly, aseites, patchy in homogeneous density within the liver. Pathohistological findings show narrowing of lumen of hepatic venules, occlusion of blood vessels surrounding the hepatic venules, liquefaction and necrosis of hepatic cells at its early stage, and fibrosis at its late stage. Early diagnosis and early treatment may probably improve the prognosis. Clinicians should raise the HVOD recognition, and alert the patient not to abuse chrysanthemum-like groundsel.