含吡咯烷生物碱的中草药与肝小静脉闭塞病

目的 总结分析含吡咯烷生物碱(PAs)的中草药导致肝小静脉闭塞病(HVOD)的临床特点,提高对HVOD的病因及诊治认识.方法 对1980年至2006年国内报道的中草药导致HVOD病例10例,以及北京协和医院诊断的中草药导致HVOD 3例进行综合分析,并进行国内外相关文献复习.结果 国内报道的中草药致HVOD病例以土三七为主,占84.6%(11/13).土三七用量150 g～1 800 g(平均约582 g),用药持续时间10余天至4个月(平均42.5天);千里光致病者1例,嗜食茶叶致病者1例.HVOD临床症状主要为腹部胀痛、腹水、肝大、黄疸,可有不同程度的肝功能受损,多有GGT及ALP升高;超声下可见门脉血流减慢以及CT下不均匀脂肪肝样表现为其影像学特点;通过组织学诊断(9/13)和临床诊断(4/13).保守治疗好转者2例,肝移植2例,死亡5例.结论 含有吡咯烷生物碱的中草药是导致HVOD的一个重要原因,临床上应慎用此类药物.影像学检查有一定的特点,早期临床诊断对改善预后非常重要.

Traditional Chinese Medicine Containing Pyrrolizidine Alkaloids and Hepatic Veno-Occlusive Disease

Objective To improve the understanding of the etiology,diagnosis and treatment of hepatic veno-occlusive disease(HVOD),we analyze the clinical features of HVOD caused by traditional Chinese medicine(TCM) containing pyrrolizidine alkaloids(PAs).Methods Retrospectively analyze the clinical data of 10 cases with HVOD caused by TCM reported from 1980 to 2006 in China,and that of 3 cases with HVOD caused by TCM in PUMCH,and review the related literatures.Results 11 of the 13 cases(84.6%) were caused by gynura root,which were dosed from 150 g to 1 800 g(average 582 g),lasted for over 10 days to 4 months(average 42.5 days).One of the 13 cases was caused by qianliguang,and one was caused by tea-thirsty.The main symptoms were abdominal distention and pain,ascites,hepatomegaly and jaundice.Liver function may be abnormal mand GGT and ALP mostly increased.The imaging features were slow flow of portal vein by ultrasound and patchy fatty-liver liked changes by CT.9 of the 13 cases were diagnosed by pathology,and 4 were diagnosed according to clinical features.2 cases got improvement by medical treatment,2 got liver-transplantation,and 5 cases died.Conclusion TCM containing pyrrolizidine alkaloids is an important cause of HVOD,and it should by used with cautious.Early diagnosis is valuable to improve prognosis.