土三七引起肝静脉闭塞性疾病并致死亡

Senecio chrysanthemoides-induced hepatic veno-occlusive disease and death

1例62岁男性患者因外伤自行服用土三七粉,每日约15 g。半年后,患者出现腹水。停服土三七。在当地医院接受保肝治疗无效并出现重度黄疸和肝性脑病,遂转入我院。实验室检查:血小板计数13×109/L,蛋白总量37 g/L,胆红素总量128.9μmol/L,直接胆红素103.3μmol/L,丙氨酸转氨酶104 U/L,肌酐298μmol/L,尿素氮38.1 mmol/L,尿酸975μmol/L,凝血酶原时间31.7 s,凝血酶原活动度26%,C反应蛋白16 mg/L,肌酸激酶383 U/L。诊断为药物引起的肝静脉闭塞性疾病。虽经保肝、退黄、抗炎、利尿、营养等治疗,但患者进展为多器官功能衰竭,最终死亡。

A 62-year-old male patient self-medicated with oral senecio chrysanthemoides powder 15 g daily for injury. After half a year, the patient appeared ascites. Senecio chrysanthemoides was stopped. The hepatoprotective treatment was ineffective in the local hospital and he developed severe jaundice and hepatic encephalopathy, and then he was admitted to our hospital. Laboratory examinations showed the followed levels and values： WBC count 13 × 109/L, total protein 37 g/L, total bilirubin 128.9 μmol/L, direct bilirubin 103.3 μmol/L, alanine aminotransferase 104 U/L, serum creatinine 298 μmol/L, blood urea nitrogen 38.1 mmol/L, uric acid 975 μmol/L, prothrombin time 31.7 seconds, prothrombin activity 26% , C-reactive protein 16 mg/L, creatine kinase 383 U/L. Drug-induced hepatic veno-occlusive disease was diagnosed. Despite treatment with liver-protective drugs, medications used to treat jaundice, anti-infective drugs, diuretics, and nutritional support, patient progressed to multiple organ failure and eventually died.