肝窦阻塞综合征患者临床及影像学表现分析

Clinical and imaging analysis of patients with hepatic sinusoidal obstruction syndrome

目的分析肝窦阻塞综合征(HSOS)患者临床及影像学表现(CT或MR),提高对本病的诊断水平。方法回顾性分析2010年11月至2019年11月解放军总医院第五医学中心收治的40例HSOS患者的发病原因、临床表现、实验室检查及影像学表现。结果 40例HSOS患者中,31例有明确的药物服用史,以服用"土三七"者最多,占65.0%(26/40),5例为肝移植术后,1例为肾移植术后,3例病因不明。主要临床表现为腹胀、乏力、腹水等。实验室检查以天冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、总胆红素(TBil)及直接胆红素(DBil)水平升高为主,分别占60.0%(24/40)、77.5%(31/40)、75.0%(30/40)、87.5%(35/40),同时96.4%(27/28)的患者糖类抗原125 (CA125)水平升高显著,D-二聚体水平升高较为常见(95.2%,20/21)。影像学表现为肝脏弥漫性肿大,增强扫描肝实质呈"花斑样""地图状"不均匀强化,延迟期强化明显,肝静脉周围肝实质强化程度较高,表现为特征性的"三叶草征",肝静脉狭窄或显示不清,下腔静脉受压变细,同时常合并有腹水、胸腔积液及胆囊炎等肝外征象。结论 HSOS发病原因多样,以服用"土三七"为主,结合患者的发病原因、临床表现、实验室检查及影像学表现,可对该病做出正确诊断。

Objective To explore the clinical and imaging manifestations(CT or MR) of hepatic sinusoidal obstruction syndrome(HSOS),and improve the diagnosis of this disease.Methods The etiology,clinical manifestations,laboratory examinations and imaging findings of 40 HSOS patients admitted to the Fifth Medical Center of the PLA General Hospital from November 2010 to November 2019 were retrospectively analyzed.Results Among the 40 HSOS patients,31 had a clear history of drug use.Among them,"Tusanqi" took the most,accounting for 65.0%(26/40).Five cases were after liver transplantation,1 case was after kidney transplantation,and 3 cases had unknown etiology.The main clinical manifestations were abdominal distension,fatigue,ascites,etc.In laboratory tests,the levels of aspartate aminotransferase(AST),γ-glutamyltransferase(GGT),total bilirubin(TBil) and direct bilirubin(DBil) were mainly increased,accounting for 60.0%(24/40),77.5%(31/40),75.0%(30/40) and 87.5%(35/40),respectively.Meanwhile,the level of carbohydrate antigen 125(CA125) was significantly increased in 96.4%(27/28) patients,and elevated D-dimer levels were more common(95.2%,20/21).Imaging manifestations showed diffuse enlargement of the liver.The enhanced scanning showed liver parenchyma "plate-like" and "map-like" uneven enhancement,obvious enhancement in delayed phase,high degree of enhancement of liver parenchyma around hepatic veins,showing characteristic "clover sign",hepatic vein stenosis or unclear display,compression inferior vena cava and thinning,often accompanied by ascites,pleural fluid,cholecystitis and other extrahepatic signs.Conclusions There are various causes of HSOS,and the main reason is taking "Tusanqi".Combined with the causes of the disease,clinical manifestations,laboratory examination and imaging manifestations,the correct diagnosis of the disease can be made.