吡咯生物碱相关肝窦阻塞综合征诊断和治疗专家共识意见(2017年,南京)

中华医学会消化病学分会肝胆疾病协作组

doi:10.3969/j.issn.1001-5256.2017.09.003

吡咯生物碱相关肝窦阻塞综合征诊断和治疗专家共识意见(2017年,南京)

DOI: 10.3969/j.issn.1001-5256.2017.09.003

中华医学会消化病学分会肝胆疾病协作组

基金项目:

基金项目:江苏省消化系统疾病及消化道肿瘤临床医学中心(YXZXB2016002)；

详细信息

中图分类号: R575
计量
- 文章访问数: 374
- HTML全文浏览量: 27
- PDF下载量: 981
- 被引次数: 0
出版历程
- 出版日期: 2017-09-20

Expert consensus on diagnosis and treatment of pyrrolidine alkaloids-related sinusoidal obstruction syndrome (2017, Nanjing)

Cooperative Group for Hepatic and Gall Diseases, Chinese Society of Gastroenterology, Chinese Medical Association

Research funding:

摘要

摘要:
<正>肝窦阻塞综合征（hepatic sinusoidal obstruction syndrome,HSOS）,又称肝小静脉闭塞病（hepatic venoocclusive disease,HVOD）,是由各种原因导致的肝血窦、肝小静脉和小叶间静脉内皮细胞水肿、坏死、脱落进而形成微血栓,引起肝内淤血、肝损伤和门静脉高压的一种肝脏血管性疾病[1-4]。2002年,De Leve等[5]基于实验和病理研究发现,建议以HSOS代替HVOD。在近年发表的文献中上述两种名称均有使用。因此,在本共识中我们认同HSOS和HVOD可以相互替换[6]。
- 肝静脉闭塞性疾病 /
- 诊断 /
- 治疗 /
- 共识
- hepatic veno-occlusive disease /
- diagnosis /
- therapy /
- consensus

HTML全文

参考文献(74)

[1]WANG JY, GAO H.Tusanqi and hepatic sinusoidal obstruction syndrome[J].J Dig Dis, 2014, 15 (3) :105-107.

[2]GAO H, LI N, WANG JY, et al.Definitive diagnosis of hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids[J].J Dig Dis, 2012, 13 (1) :33-39.

[3]LIN G, WANG JY, LI N, et al.Hepatic sinusoidal obstruction syndrome associated with consumption of Gynura segetum[J].J Hepatol, 2011, 54 (4) :666-673.

[4]XU ZM, ZHUGE YZ, XU TS, et al.Raise the recognition of hepatic veno-occlusive disease induced by Chrysanthemum-like Groundsel[J].Chin J Gastroenterol, 2009, 14 (10) :577-579. (in Chinese) 徐肇敏, 诸葛宇征, 徐天舒.提高对“土三七”致肝小静脉闭塞病的认识[J].胃肠病学, 2009, 14 (10) :577-579.

[5]DELEVE LD, SHULMAN HM, MCDONALD GB.Toxic injury to hepatic sinusoids:sinusoidal obstruction syndrome (veno-occlusive disease) [J].Semin Liver Dis, 2002, 22 (1) :27-42.

[6]FAN CQ, CRAWFORD JM.Sinusoidal obstruction syndrome (hepatic veno-occlusive disease) [J].J Clin Exp Hepatol, 2014, 4 (4) :332-346.

[7]ZHANG YT, LI S, ZHOU DH, et al.Clinical features of sinusoidal obstruction syndrome:an analysis of 35 cases and literature review[J].J Clin Hepatol, 2013, 29 (12) :936-939. (in Chinese) 张艳亭, 李爽, 周东辉, 等.肝窦阻塞综合征35例临床分析及文献复习[J].临床肝胆病杂志, 2013, 29 (12) :936-939.

[8]ZHU WL, CHEN SH, CHEN WX, et al.Clinical analysis of 50 cases of hepatic veno-occlusive disease[J].Chin J Dig, 2012, 32 (9) :620-624. (in Chinese) 朱晚林, 陈韶华, 陈卫星, 等.肝小静脉闭塞病50例临床分析[J].中华消化杂志, 2012, 32 (9) :620-624.

[9]GU C, ZOU XP, XU ZM, et al.Clinical features of hepatic venoocclusive disease caused by Gynura segetum (Lour.) Merr.[J].Chin J Dig, 2010, 30 (10) :771-772. (in Chinese) 顾超, 邹晓平, 徐肇敏, 等.土三七致肝小静脉闭塞病的临床特点分析[J].中华消化杂志, 2010, 30 (10) :771-772.

[10]DIGNAN FL, WYNN RF, HADZIC N, et al.BCSH/BSBMTguideline:diagnosis and management of veno-occlusive disease (sinusoidal obstruction syndrome) following haematopoietic stem cell transplantation[J].Br J Haematol, 2013, 163 (4) :444-457.

[11]MOHTY M, MALARD F, ABECASSIS M, et al.Sinusoidal obstruction syndrome/veno-occlusive disease:current situation and perspectives-a position statement from the European Society for Blood and Marrow Transplantation (EBMT) [J].Bone Marrow Transplant, 2015, 50 (6) :781-789.

[12]DELEVE LD, VALLA DC, GARCIA-TSAO G.Vascular disorders of the liver[J].Hepatology, 2009, 49 (5) :1729-1764.

[13]SENZOLO M, RIGGIO O, PRIMIGNANI M.Vascular disorders of the liver:recommendations from the Italian Association for the Study of the Liver (AISF) ad hoc committee[J].Dig Liver Dis, 2011, 43 (7) :503-514.

[14]European Association for the Study of the Liver.EASL clinical practice guidelines:vascular diseases of the liver[J].J Hepatol, 2016, 64 (1) :179-202.

[15]HILL KR, RHODES K, STAFFORD JL, et al.Serous hepatosis:a pathogenesis of hepatic fibrosis in Jamaican children[J].Br Med J, 1953, 1 (4802) :117-122.

[16]BRAS G, JELLIFFE DB, STUART KL.Veno-occlusive disease of liver with nonportal type of cirrhosis, occurring in Jamaica[J].AMA Arch Pathol, 1954, 57 (4) :285-300.

[17]DELEVE LD, MCCUSKEY RS, WANG X, et al.Characterization of a reproducible rat model of hepatic veno-occlusive disease[J].Hepatology, 1999, 29 (6) :1779-1791.

[18]LI Y, XU JM.Clinical analysis of 11 cases of hepatic veno-occlusive disease caused by Chinese herbal medicine[J].J Clin Hepatol, 2011, 27 (2) :140-142. (in Chinese) 李杨, 许建明.中草药致肝小静脉闭塞病11例临床分析[J].临床肝胆病杂志, 2011, 27 (2) :140-142.

[19]WANG Q, LU ZM, GUO T.Traditional chinese medicine containing pyrrolizidine alkaloids and hepatic veno-occlusive disease[J].Chin JClin Gastroenterol, 2008, 20 (1) :22-25. (in Chinese) 王强, 鲁重美, 郭涛.含吡咯烷生物碱的中草药与肝小静脉闭塞病[J].临床消化病杂志, 2008, 20 (1) :22-25.

[20]LI YJ, GU C, ZHUGE YZ.Clinical characteristics of hepatic veno-occlusive disease:an alysis of 16 cases[J].Chin J Clin Res, 2012, 25 (2) :122-124. (in Chinese) 李昱江, 顾超, 诸葛宇征.肝小静脉闭塞病16例临床分析[J].中国临床研究, 2012, 25 (2) :122-124.

[21]REN L, HU S, ZHU WD, et al.Hepatic veno-occlusive disease:a clinical analysis of 14 cases[J].Clin Focus, 2015, 30 (1) :100-103. (in Chinese) 任雷, 胡粟, 朱卫东, 等.肝小静脉闭塞病14例临床分析[J].临床荟萃, 2015, 30 (1) :100-103.

[22] XU JM.A national multicenter clinical investigation of hepatic veno-occlusive disease[C].Collected papers from the 11th National Academic Conference on Digestive Diseases by Chinese Medical Association, 2011:42-44. (in Chinese) 许建明.肝小静脉闭塞病全国多中心临床调研分析[C].中华医学会第11次全国消化系疾病学术会议论文集, 2011:42-44.

[23]DELEVE LD, ITO Y, BETHEA NW, et al.Embolization by sinusoidal lining cells obstructs the microcirculation in rat sinusoidal obstruction syndrome[J].Am J Physiol Gastrointest Liver Physiol, 2003, 284 (6) :g1045-g1052.

[24]SHAO H, CHEN HZ, ZHU JS, et al.Computed tomography findings of hepatic veno-occlusive disease caused by Sedum aizoon with histopathological correlation[J].Braz J Med Biol Res, 2015, 48 (12) :1145-1150.

[25]ZHOU H, WANG YX, LOU HY, et al.Hepatic sinusoidal obstruction syndrome caused by herbal medicine:CT and MRI features[J].Korean J Radiol, 2014, 15 (2) :218-225.

[26]KAN X, YE J, RONG X, et al.Diagnostic performance of Contrast-enhanced CT in pyrrolizidine alkaloids-induced hepatic sinusoidal obstructive syndrome[J].Sci Rep, 2016, 6:37998.

[27]ZHANG LX, WU JP, XU H, et al.The diagnosis and differential diagnosis of hepatic veno-occlusive disease[J].J Intervent Radiol, 2012, 21 (12) :987-990. (in Chinese) 张璐西, 吴金平, 徐浩, 等.肝小静脉闭塞病的诊断与鉴别诊断[J].介入放射学杂志, 2012, 21 (12) :987-990.

[28]MATTOCKS AR.Toxicity of pyrrolizidine alkaloids[J].Nature, 1968, 217 (5130) :723-728.

[29]HUXTABLE RJ.Activation and pulmonary toxicity of pyrrolizidine alkaloids[J].Pharmacol Ther, 1990, 47 (3) :371-389.

[30]CHOJKIER M.Hepatic sinusoidal-obstruction syndrome:toxicity of pyrrolizidine alkaloids[J].J Hepatol, 2003, 39 (3) :437-446.

[31]EDGAR JA, MOLYNEUX RJ, COLEGATE SM.Pyrrolizidine alkaloids:potential role in the etiology of cancers, pulmonary hypertension, congenital anomalies, and liver disease[J].Chem Res Toxicol, 2015, 28 (1) :4-20.

[32]CHEN Z, HUO JR.Hepatic veno-occlusive disease associated with toxicity of pyrrolizidine alkaloids in herbal preparations[J].Neth J Med, 2010, 68 (6) :252-260.

[33]YANG M, RUAN J, FU PP, et al.Cytotoxicity of pyrrolizidine alkaloid in human hepatic parenchymal and sinusoidal endothelial cells:Firm evidence for the reactive metabolites mediated pyrrolizidine alkaloid-induced hepatotoxicity[J].Chem Biol Interact, 2016, 243:119-126.

[34]DELEVE LD, WANG X, KUHLENKAMP JF, et al.Toxicity of azathioprine and monocrotaline in murine sinusoidal endothelial cells and hepatocytes:the role of glutathione and relevance to hepatic venoocclusive disease[J].Hepatology, 1996, 23 (3) :589-599.

[35]WANG X, KANEL GC, DELEVE LD.Support of sinusoidal endothelial cell glutathione prevents hepatic veno-occlusive disease in the rat[J].Hepatology, 2000, 31 (2) :428-434.

[36]DELEVE LD, WANG X, TSAI J, et al.Sinusoidal obstruction syndrome (veno-occlusive disease) in the rat is prevented by matrix metalloproteinase inhibition[J].Gastroenterology, 2003, 125 (3) :882-890.

[37]YU XZ, JI T, BAI XL, et al.Expression of MMP-9 in hepatic sinusoidal obstruction syndrome induced by Gynura segetum[J].JZhejiang Univ Sci B, 2013, 14 (1) :68-75.

[38]DELEVE LD, WANG X, KANEL GC, et al.Decreased hepatic nitric oxide production contributes to the development of rat sinusoidal obstruction syndrome[J].Hepatology, 2003, 38 (4) :900-908.

[39]LI YH, TAI WC, XUE JY, et al.Proteomic study of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome in rats[J].Chem Res Toxicol, 2015, 28 (9) :1715-1727.

[40]HARB R, XIE G, LUTZKO C, et al.Bone marrow progenitor cells repair rat hepatic sinusoidal endothelial cells after liver injury[J].Gastroenterology, 2009, 137 (2) :704-712.

[41]VALLA DC, CAZALS-HATEM D.Sinusoidal obstruction syndrome[J].Clin Res Hepatol Gastroenterol, 2016, 40 (4) :378-385.

[42] ZHU CK, ZHANG F, ZHUGE YZ, et al.Clinical features of sinusoidal obstruction syndrome caused by Gynura segetum (Lour.) Merr.:an analysis of 115 cases[J].Chin J Dig, 2017, 37 (7) :448-452. (in Chinese) 朱成凯, 张峰, 诸葛宇征, 等.115例土三七致肝窦阻塞综合征的临床特点分析[J].中华消化杂志, 2017, 37 (7) :448-452.

[43]GAO H, RUAN JQ, CHEN J, et al.Blood pyrrole-protein adducts as a diagnostic and prognostic index in pyrrolizidine alkaloidhepatic sinusoidal obstruction syndrome[J].Drug Des Devel Ther, 2015, 9:4861-4868.

[44]RUAN J, GAO H, LI N, et al.Blood pyrrole-protein adductsbiomarker of pyrrolizidine alkaloid-induced liver injury in humans[J].J Environ Sci Health C Environ Carcinog Ecotoxicol Rev, 2015, 33 (4) :404-421.

[45]CHEN S, LI CL, GAO YY.Application of color doppler ultrasound in diagnosing hepatic veno-occlusive disease[J].Chin J Med Imaging, 2010, 18 (2) :154-156. (in Chinese) 陈爽, 李春伶, 高永艳.彩色多普勒超声对肝小静脉闭塞症的诊断价值[J].中国医学影像学杂志, 2010, 18 (2) :154-156.

[46]JIAGN TA, WENG HF, AO JY, et al.Significance of ultrasonography in diagnosing hepatic sinusoidal abstructive syndrome[J].Chin J Ultrasound Med, 2008, 24 (10) :951-955. (in Chinese) 蒋天安, 翁慧芳, 敖建阳, 等.超声影像对肝窦阻塞综合征的诊断价值[J].中国超声医学杂志, 2008, 24 (10) :951-955.

[47]YU S, FANG ZT, BAO Q, et al.Imaging findings of sinusoidal obstruction syndrome:an analysis of 6 cases[J].Chin J Med Imaging, 2013, 11:861-863. (in Chinese) 俞顺, 方主亭, 包强, 等.肝窦阻塞综合征6例影像学表现[J].中国医学影像学杂志, 2013, 11:861-863.

[48]YANG J, HAN H, LI X, et al.Evaluation of acoustic radiation force impulse imaging combined with color Doppler ultrasonography in patients with hepatic veno-occlusive disease after taking Gynura segetum[J].J Clin Ultrasound in Med, 2016, 18 (9) :597-600. (in Chinese) 杨建, 韩浩, 李霞, 等.彩色多普勒超声联合声辐射力脉冲成像诊断菊叶三七致肝小静脉闭塞病的应用价值[J].临床超声医学杂志, 2016, 18 (9) :597-600.

[49]ZHANG GH, KONG AZ, FANG JW, et al.CT imaging of hepatic veno-occlusive disease (an analysis 14 cases) [J].Chin J Radiol, 2006, 40 (3) :250-254. (in Chinese) 张国华, 孔阿照, 方军伟, 等.肝小静脉闭塞病的CT表现 (附14例分析) [J].中华放射学杂志, 2006, 40 (3) :250-254.

[50]SHI TT, HE J, SHI J, et al.CT features of hepatic veno-occlusive disease caused by Gynura segetum[J].J Pract Radiol, 2016, 32 (6) :875-878. (in Chinese) 施婷婷, 何健, 史炯, 等.土三七致肝小静脉闭塞症的CT影像分析[J].实用放射学杂志, 2016, 32 (6) :875-878.

[51]WU XW, WANG WQ, LIU B, et al.Hepatic veno-occlusive disease after taking Gynura Rhizome:the value of multidetector computed tomography in diagnosing the disease and evaluating the clinical therapeutic effect[J].Hepatol Res, 2012, 42 (3) :304-309.

[52]PEI YG, HU DY, SHEN YQ, et al.The value of MSCT and MRI in the diagnosis of hepatic veno-occlusive disease[J].Chin J Hepatol, 2010, 18 (2) :150-152. (in Chinese) 裴贻刚, 胡道予, 沈亚琪, 等.多层螺旋CT与核磁共振成像对肝小静脉闭塞病的诊断价值[J].中华肝脏病杂志, 2010, 18 (2) :150-152.

[53]YE TH, LIAGN HM, YE J, et al.CT and MR findings of hepatic sinusoidal obstruction syndrome caused by Gynura segetum[J/CD].Chin J Interv Radiol:Electronic Edition, 2015, 3 (1) :27-33. (in Chinese) 叶天和, 梁惠民, 叶进, 等.土三七致肝窦阻塞综合征的CT及MRI诊断[J/CD].中华介入放射学电子杂志, 2015, 3 (1) :27-33.

[54]ZHAGN M, ZHUGE YZ, CHEN J.A typical hepatic veno-occlusive disease confirmed by measurement of hepatic venous pressure gradient and transjugular liver biopsy:a case report[J].Chin JDig, 2013, 33 (9) :636-637. (in Chinese) 张明, 诸葛宇征, 陈骏.肝静脉压力梯度测定和经颈静脉肝活组织检查确诊不典型肝小静脉闭塞病一例[J].中华消化杂志, 2013, 33 (9) :636-637.

[55]LIU YL.Sinusoidal obstruction syndrome:issues and challenges in clinical diagnosis and treatment[J].Chin J Dig, 2015, 35 (2) :73-76. (in Chinese) 刘玉兰.肝窦阻塞综合征:临床诊治面临的问题与挑战[J].中华消化杂志, 2015, 35 (2) :73-76.

[56]de la RUBIA J, CARRAL A, MONTES H, et al.Successful treatment of hepatic veno-occlusive disease in a peripheral blood progenitor cell transplant patient with a transjugular intrahepatic portosystemic stent-shunt (TIPS) [J].Haematologica, 1996, 81 (6) :536-539.

[57]HOPPS SA, BORDERS EB, HAGEMANN TM.Prophylaxis and treatment recommendations for sinusoidal obstruction syndrome in adult and pediatric patients undergoing hematopoietic stem cell transplant:a review of the literature[J].J Oncol Pharm Pract, 2016, 22 (3) :496-510.

[58]YANG L, HUO JR, ZHU HY, et al.Clinical effect of Salvia miltiorrhiza in prevention and treatment of hepatic veno-occlusive disease induced by Gynura segetum (Lour.) Merr.in mice[J].Chin Hepatol, 2013, 18 (2) :105-107. (in Chinese) 杨丽, 霍继荣, 朱洪怡, 等.丹参对土三七诱导小鼠肝小静脉闭塞病预防治疗效果的观察[J].肝脏, 2013, 18 (2) :105-107.

[59]WANG JY, ZHAGN GY, ZHU YM, et al.Clinical features of 9 cases of sinusoidal obstruction syndrome[J].J Capit Med Univ, 2014, 35 (5) :604-607. (in Chinese) 王峻瑶, 张国艳, 朱元民, 等.肝窦阻塞综合征9例的临床分析[J].首都医科大学学报, 2014, 35 (5) :604-607.

[60]ZHOU HH, XU XL, GUAN X, et al.Hepatic veno-occlusive disease induced by senecio chrysanthemoides:An analysis of 13 cases and literature review[J].J Pract Hepatol, 2015, 18 (3) :304-305. (in Chinese) 周宏华, 徐晓玲, 关心, 等.土三七致肝小静脉闭塞病13例报道及文献复习[J].实用肝脏病杂志, 2015, 18 (3) :304-305.

[61]LING M, WU QH.Hepatic veno-occlusive disease induced by senecio chrysanthemoides (Tusanqi) in 81 patients:analysis of literature[J].ADRJ, 2013, 15 (5) :254-257. (in Chinese) 凌美, 武谦虎.土三七致肝小静脉闭塞症81例文献分析[J].药物不良反应杂志, 2013, 15 (5) :254-257.

[62]WU XJ, ZHANG K, YU MY, et al.Clinical analysis of four cases of hepatic veno-occlusive disease caused by Gynura segetum (Lour.) Merr[J].Chin J Hepatol, 2007, 15 (2) :151-153. (in Chinese) 吴新军, 张魁, 俞孟勇, 等.菊叶三七致肝小静脉闭塞病4例[J].中华肝脏病杂志, 2007, 15 (2) :151-153.

[63]ZHU H, CHU Y, HUO J, et al.Effect of prednisone on transforming growth factor-beta1, connective tissue growth factor, nuclear factor-kappa Bp65 and tumor necrosis factor-alpha expression in a murine model of hepatic sinusoidal obstruction syndrome induced by Gynura segetum[J].Hepatol Res, 2011, 41 (8) :795-803.

[64]XU XJ, CHEN HT, SHAN GD.Diagnosis and treatment of sinusoidal obstruction syndrome caused by Gynura segetum (Lour.) Merr.:an analysis of 42 cases[J/CD].Chin J Crit Care Med:E-lectronic Editon, 2010, 3 (3) :178-180. (in Chinese) 徐小俊, 陈洪潭, 单国栋.土三七致肝窦阻塞综合征42例诊治分析[J/CD].中华危重症医学杂志:电子版, 2010, 3 (3) :178-180.

[65]SONG Y, FAN HY.Clinical features of hepatic veno-occlusive disease induced by gynura root:analysis of 102 cases[J].J Clin Hepatol, 2011, 27 (5) :496-499. (in Chinese) 宋宇, 樊艳华.土三七所致肝小静脉闭塞病102例临床分析[J].临床肝胆病杂志, 2011, 27 (5) :496-499.

[66]WANG Y, ZHUGE YZ, ZHAGN F, et al.Treatment for Gynura segetum caused hepatic vein occlusive disease:a single-center retrospective study[J].Chin J Dig, 2016, 36 (12) :811-815. (in Chinese) 王轶, 诸葛宇征, 张峰, 等.土三七致肝小静脉闭塞病治疗的单中心回顾性研究[J].中华消化杂志, 2016, 36 (12) :811-815.

[67]ZENZ T, ROSSLE M, BERTZ H, et al.Severe veno-occlusive disease after allogeneic bone marrow or peripheral stem cell transplantation-role of transjugular intrahepatic portosystemic shunt (TIPS) [J].Liver, 2001, 21 (1) :31-36.

[68]ALVAREZ R, BANARES R, CASARIEGO J, et al.Percutaneous intrahepatic portosystemic shunting in the treatment of veno-occlusive disease of the liver after bone marrow transplantation[J].Gastroenterol Hepatol, 2000, 23 (4) :177-180.

[69]AZOULAY D, CASTAING D, LEMOINE A, et al.Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation[J].Bone Marrow Transplant, 2000, 25 (9) :987-992.

[70]WANG Y, ZHAGN F, ZHAGN M, et al.Efficacy transjugularintrahepatic portosystemic stent-shunt gynurasegetum induced hepatic veno-occlusive disease refractoryascites[J].World Chin J Dig, 2015, 23 (26) :4261-4265. (in Chinese) 王轶, 张峰, 张明, 等.经颈静脉肝内门腔静脉分流术治疗误服土三七后肝小静脉闭塞所致顽固性腹水的疗效[J].世界华人消化杂志, 2015, 23 (26) :4261-4265.

[71]HAUSSMANN U, FISCHER J, EBER S, et al.Hepatic veno-occlusive disease in pediatric stem cell transplantation:impact of pre-emptive antithrombin III replacement and combined antithrombin III/defibrotide therapy[J].Haematologica, 2006, 91 (6) :795-800.

[72]NAKAMURA D, YOSHIMITSU M, KAWADA H, et al.Recombinant human soluble thrombomodulin for the treatment of hepatic sinusoidal obstructive syndrome post allogeneic hematopoietic SCT[J].Bone Marrow Transplant, 2012, 47 (3) :463-464.

[73]BARKHOLT L, REMBERGER M, HASSAN Z, et al.A prospective randomized study using N-acetyl-L-cysteine for early liver toxicity after allogeneic hematopoietic stem cell transplantation[J].Bone Marrow Transplant, 2008, 41 (9) :785-790.

[74]YOON JH, MIN WS, KIM HJ, et al.Experiences of t-PA use in moderate-to-severe hepatic veno-occlusive disease after hematopoietic SCT:is it still reasonable to use t-PA?[J].Bone Marrow Transplant, 2013, 48 (12) :1562-1568.

施引文献

资源附件(0)

访问统计