土三七致肝小静脉闭塞病治疗的单中心回顾性研究

Treatment for Gynura segetum caused hepatic vein occlusive disease： a single-center retrospective study

目的探讨采用不同治疗方法对由食用土三七所致的肝小静脉闭塞病（HVOD）患者预后的影响。方法纳入2008年7月至2016年1月因食用土三七而导致HVOD的85例患者，均给予基础保肝和改善微循环等对症治疗，再根据不同治疗方案分成非抗凝治疗组、非抗凝治疗转经颈静脉肝内门体静脉分流术（TIPS）组、抗凝治疗组、抗凝治疗转TIPS组和抗凝-TIPS阶梯治疗组，观察各组的临床疗效。统计学分析采用卡方检验。结果22例未采用抗凝治疗的患者中，6例（27.3%）临床治愈，14例（63.6%）在治疗期间死亡，2例（9.1%）因治疗无效而接受TIPS治疗并长期存活。63例采用低分子肝素联合华法林抗凝治疗的患者中，6例（9.5%）死亡，36例（57.1%）临床治愈，治愈率高于非抗凝治疗组（χ2＝5.820，P＝0.016）；另有21例患者接受TIPS治疗，其中1例因手术失败而死于手术并发症，其余患者均长期存活。抗凝-TIPS阶梯治疗组的临床治愈率为88.9%（56/63），高于非抗凝治疗组，差异有统计学意义（χ2＝31.350，P〈0.01）。结论与常规的保肝和对症治疗相比，抗凝治疗显著提高了土三七所致HVOD患者的临床治愈率。抗凝-TIPS阶梯治疗则进一步提高了其治愈率。

ObjectiveTo explore the effects of different treatments on prognosis of patients with Gynura segetum caused hepatic vein occlusion disease （HVOD）.MethodsFrom July 2008 to January 2016, 85 patients with Gynura segetum caused HVOD were enrolled and received treatment of liver function protection and microcirculation rovement. According to different treatment options, patients were divided into non-anticoagulation group, non-anticoagulation transfered to transjugular intrahepatic portosystem stent-shunt （TIPS） group, anticoagulation group, anticoagulation transfered to TIPS group and anticoagulation-TIPS step-by-step treatment group. The efficacy of each group was observed. Chi-square test was performed for statistical analysis.ResultsAmong 22 patients who received non-anticoagulation treatment, six （27.3%） patients were cured and 14（63.6%） patients died during the treatment period; besides two （9.1%） patients received TIPS because of ineffective treatment and achieved long-term survival. Among 63 patients treated with combination of low-molecular-weight heparin and warfarin, six （9.5%） patients died and 36（57.1%） patients were cured. The cure rate was higher than that of non-anticoagulation group （χ2=5.820, P=0.016）. Other 21 patients received TIPS treatment, achieved long-term survival except one patient died from surgical complications. The cure rate of anticoagulation-TIPS step treatment group was 88.9% （56/63） which was higher than that of non-anticoagulation group, and the difference was statistically significant （χ2=31.350, P〈0.01）.ConclusionsCompared to conventional liver function protection treatment and symptomatic treatment, anticoagulation therapy significantly increases the cure rate of patients with Gynura segetum caused HVOD. Anticoagulation-TIPS step-by-step treatment further improves the cure rate.