吴玉华++武谦虎

[摘要] 本文回顾性分析了江苏省镇江市第三人民医院近5年发生的9例土三七致肝小静脉闭塞症，其中男5例，女4例，年龄23～73岁，平均（57.89±15.79）岁。9例患者中，原发疾病均为骨伤科疾病，伴有慢性肝病者5例。所有患者均为自行服用土三七。发病时间为用药后1周～2年。临床主要表现为腹胀、腹痛、腹水、肝大、黄疸等不同程度的肝功能损伤。实验室检查以肝功能和凝血功能指标异常为主，全部病例均经CT选择性肝静脉造影或病理检查确诊。经停药与保肝等对症治疗，1例治愈，7例好转，1例死亡。提醒临床上应高度重视土三七致肝小静脉闭塞症的这种严重不良反应。

[关键词] 土三七/菊三七；肝小静脉闭塞症；药物不良反应；药源性疾病

[中图分类号] R97 [文献标识码] A [文章编号] 1673-7210（2016）12（b）-0161-04

Clinical characteristics of hepatic veno-occlusive disease by senecio chrysanthemoides：analysis of 9 cases

WU Yuhua WU Qianhu

Office of Drug Clinical Trial Institutions， the Third People′s Hospital of Zhenjiang City， Jiangsu Province， Zhenjiang 212000， China

[Abstract] This article retrospectively analyzes 9 patients with hepatic veno-occlusive disease induced by senecio chrysanthemoides in the recent 5 years in the Third People′s Hospital of Zhenjiang City， Jiangsu Province. Among them 5 are males， and 4 are females， and they are aged from 23 to 73 with the average of （57.89±15.79） years. All of the 9 patients′ primary diseases are orthopedic problems and 5 patients have chronic hepatic diseases. All patients take the drugs by themselves. The time of onset is 1 week to 2 years after taking the drugs. The main clinical manifestations are abdominal distention， abdominal pain， ascites， hepatomegaly， jaundice and different degrees of liver damage. Laboratory examination mainly showes abnormal liver function and abnormal blood coagulation function. All the cases are diagnosed via CT selective hepatic vein angiography or pathological examination. After the drugs withdrawal and supportive liver protection treatments， 1 patient is cured， 7 are improved， and 1 died. It is a reminder that clinical practice should pay high attention to the serious adverse reaction of hepatic veno-occlusive disease induced by senecio chrysanthemoides.

[Key words] Senecio ehrysanthemoides/Herba gynurae segeti； Hepatic veno-occlusive disease； Drug adverse reaction； Drug induced disease

肝小靜脉闭塞症（HVOD），又称窦状隙梗阻综合征，为肝循环的非血栓性梗阻，伴有肝小叶中心性窦状隙纤维化及常见肝小静脉的纤维化狭窄或者闭塞。临床出现肝脏肿大、疼痛、腹水等，半数以上患者经及时治疗可以康复，20%的患者死于肝衰竭，少数患者发展为肝硬化门脉高压[1-2]。HVOD在我国为较少见的稀有疾病，但近十年来，土三七所致HVOD病例报告屡有报道，虽然报道总病例数不多，但大多较为严重，治疗十分困难。现将江苏省镇江市第三人民医院（以下简称“我院”）近5年收治的服用土三七所致HVOD病例报告如下，以期临床关注和重视土三七所致这种严重药物不良反应。

1 病例资料

1.1 资料来源

选取我院2011年1月～2015年12月住院确诊和治疗的9例HVOD患者。……