奥沙利铂致肝窦阻塞综合征及其防治

Oxaliplatin induced hepatic sinusoidal obstruction syndrome： prevention and treatment

奥沙利铂为第三代铂类化合物，常用于结直肠癌的化疗。奥沙利铂可损害肝窦内皮细胞引起肝窦阻塞综合征（HSOS），发生率高达77．4％。HSOS临床表现为肝区疼痛、体重增加、腹水、肝肿大和黄疸；病理学特征为肝窦扩张充血、小叶中央静脉纤维性阻塞、窦周纤维化、小叶中央肝细胞坏死等。奥沙利铂致HSOS缺乏特异的影像学表现、生物学标志及特效治疗药物，对奥沙利铂所致HSOS应以预防为主。贝伐珠单抗、瑞戈非尼、索拉菲尼、重组人可溶性血栓调节蛋白、抗氧化剂等对于HSOS的预防可能有一定作用，去纤苷有望用于HSOS的治疗。

Oxaliplatin is the third generation of platinum drugs, used in chemotherapy of colorectal carcinoma. Oxaliplatin can injure hepatic sinusoidal endothelial cells to induce hepatic sinusoidal obstruction syndrome （HSOS）. The incidence of oxaliplatin induced HSOS was 77.4%. The clinical manifestations were hepatalgia, weight gain, ascites, hepatomegaly and jaundice. Histopathologic features include hepatic sinusoidal dilation and congestion, centrilobular vein obstruction, perisinusoidal fibrosis and centrilobular hepatic cell necrosis. The lack of typical imaging manifestations, biomarkers and effective treatment, so prevention-oriented strategy is important. Bevacizumab, regorafenib, sorafenib, recombinant human soluble thrombomodulin, and antioxidant may prevent HSOS. Defibrotide is recommended for treatment of HSOS.