土三七致HBsAg阳性患者肝小静脉闭塞病的诊断和治疗

目的 总结乙型肝炎表面抗原（HBsAg）阳性患者服用土三七致肝小静脉闭塞病（hepatic veno-occlusive disease,HVOD）的诊断和治疗经验.方法 对35例HBsAg阳性HVOD患者的临床表现、影像学检查和肝组织活检结果,以及治疗效果进行分析.结果 35例患者均有肝脏肿大、肝功能异常和腹腔积液等临床表现,肝脏CT有地图状密度改变.17例患者进行了肝组织活检,病理表现为肝细胞肿胀伴点状坏死;肝窦明显扩张、淤血;汇管区肝小静脉内皮肿胀,管壁增厚,管腔不完全闭塞.17例肝组织活检确诊的HVOD患者肝脏CT检查均有地图状密度改变.发病4周内且仅有少量腹水的15例患者通过低分子肝素、白蛋白等治疗,13例症状消失或减轻,而其他患者治疗后仅50%能够好转.结论 肝脏CT检查可替代肝组织活检诊断HVOD,在发病早期及时治疗可提高该病的治愈率.

Diagnosis and treatment of hepatic veno-occlusive disease induced by sedum aizoon in HBsAg positive patients

Objective To review the diagnosis and treatment of hepatic veno-occlusive disease（HVOD）induced by sedum aizoon in HBsAg positive patients. Methods Clinical data of 35 HBsAg positive cases who took sedum aizoon decoction and developed HVOD were collected, the clinical manifestation, imaging examination, histological examination of liver puncture biopsy, and the outcomes of patients were reviewed. Results Hepatomegaly, liver dysfunction, abdominal effusion and map-like density changes in liver CT scan were observed in 35 patients. Liver biopsy wag performed in 17 patients. In histopathological examination, the swelling and point-like necrosis of liver cells, expansion and congestion of sinus, endothelial swelling, wall thickening, incomplete lumen occlusion of small liver vascular were observed. Map-like density changes in liver CT scan were found in all 17 patients who were diagnosed by histological examination. Fifteen patients presented small amount of ascites within 4 weeks of onset, 13 of whom recovered or improved after treated with low-molecular weight heparin and albumin; while among the remaining 20 patients. only half of them were benefited from the same treatments. Conclusion HVOD can be diagnosed by liver CT scan instead of histological examination; treatment of patients in early stage may improve the outcome.