吡咯里西啶生物碱相关肝窦阻塞综合征的抗凝-经颈静脉肝内门体分流术阶梯治疗

张玮; 诸葛宇征

doi:10.3969/j.issn.1001-5256.2022.06.005

吡咯里西啶生物碱相关肝窦阻塞综合征的抗凝-经颈静脉肝内门体分流术阶梯治疗

DOI: 10.3969/j.issn.1001-5256.2022.06.005

张玮,
诸葛宇征^, ,

南京大学医学院附属鼓楼医院消化内科，南京 210004

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：张玮负责查找文献，撰写文稿；诸葛宇征负责确定写作思路，指导文章撰写及最后定稿。

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通信作者:
诸葛宇征，yuzheng9111963@aliyun.com

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出版历程
- 收稿日期: 2022-04-18
- 录用日期: 2022-05-22
- 出版日期: 2022-06-20

Anticoagulant therapy and transjugular intrahepatic portosystemic shunt for pyrrolizidine alkaloid related hepatic sinusoidal obstruction syndrome

Wei ZHANG,
Yuzheng ZHUGE^{,
,}

Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210004, China

More Information

Corresponding author: ZHUGE Yuzheng, yuzheng9111963@aliyun.com(ORCID: 0000-0002-3829-5831)

摘要

摘要: 肝窦阻塞综合征(HSOS)是以不同程度肝损伤和门静脉高压为主要临床表现的一种血管性肝脏疾病。国内HSOS大多与摄入吡咯里西啶生物碱(PA)相关。以抗凝与经颈静脉肝内门体分流术(TIPS)为核心的升阶梯疗法是目前推荐的治疗策略。抗凝治疗首选低分子肝素皮下注射，亦可联用或序贯口服华法林强化抗凝。对于抗凝治疗无应答患者可转做TIPS。PA-HSOS患者治疗过程中可应用鼓楼严重度评分系统评估病情，以期早期识别高危危重患者，及时转换TIPS治疗，从而改善患者预后。
- 肝静脉闭塞性疾病 /
- 吡咯齐定生物碱类 /
- 抗凝药 /
- 门体分流术, 经颈静脉肝内
Abstract: Hepatic sinusoidal obstruction syndrome (HSOS) is a vascular liver disease characterized by varying degrees of liver injury and portal hypertension. HSOS in China is mostly associated with the intake of pyrrolizidine alkaloids. The step-up approach with anticoagulant therapy and transjugular intrahepatic portosystemic shunt (TIPS) as the core treatment methods is the therapy currently recommended for this disease. Subcutaneous injection of low-molecular-weight heparin is the first choice for anticoagulant therapy, and oral warfarin can be used in combination or sequentially to enhance anticoagulation. Patients with no response to anticoagulant therapy can switch to TIPS. The Drum Tower Severity Score (DTSS) system can be used during treatment to evaluate the severity of the disease, in order to identify high-risk patients earlier and switch to TIPS in time, thereby improving the prognosis of patients.
- Hepatic Veno-Occlusive Disease /
- Pyrrolizidine Alkaloids /
- Anticoagulants /
- Portasystemic Shunt, Transjugular Intrahepatic

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表 1 DTSS系统

Table 1. Drum tower severity scoring

变量	1分	2分	3分	4分
AST(U/L)	＜69.75	≥69.75，＜200	≥200，＜320	≥320
TBil(μmol/L)	＜20.5	≥20.5，＜38	≥38，＜85.5	≥85.5
Fb(g/L)	＞2.35	＞1.5，≤2.35	＞1，≤1.5	≤1
PVV(cm/s)	≥20	＞15.85，＜20	≥10，≤15.85	＜10

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参考文献(12)

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