Risk factors for hepatic veno-occlusive disease caused by Gynura segetum: a retrospective study

医学 内科学 胃肠病学 肝性脑病 回顾性队列研究 肝静脉闭塞性疾病 经颈静脉肝内门体分流术 胆红素 存活率 肝病学 外科 比例危险模型 置信区间 疾病 肝硬化 门脉高压 造血干细胞移植
作者
Yan Wang,Dan Qiao,Ya Li,Feng Xu
出处
期刊:BMC Gastroenterology [BioMed Central]
卷期号:18 (1) 被引量:42
标识
DOI:10.1186/s12876-018-0879-7
摘要

Hepatic veno-occlusive disease (HVOD) caused by Gynura segetum has been increasingly reported in China in recent years. The aim of this retrospective study was to identify independent prognostic markers for survival in patients with Gynura segetum-induced HVOD and to evaluate the effect of anticoagulants and transjugular intrahepatic portosystemic shunt (TIPS) on survival rate. Clinical data including symptoms, signs, imaging characteristics, laboratory test results, results of liver tissue biopsies, type of treatment during follow-up and clinical outcomes were collected. Univariate, multivariate and time-dependent Cox regression analyses were performed. Survival rates were 91% (95% confidence interval [CI], 82–95%), 64% (95% CI, 53–69%) and 57% (95% CI, 51–65%) at 1, 3 and 60 months, respectively. Total bilirubin, albumin and hepatic encephalopathy were independent prognostic markers of survival. Anticoagulants were administered to 76% of the patients. Among 75 patients treated with anticoagulants, 49 patients (65.3%) were cured, whereas 26 patients (34.7%) died; the cure rate in anticoagulant-treated patients was higher than that of those not treated with anticoagulants (χ2 = 9.129, P = 0.004). Cure rate of the anticoagulation + TIPS treatment group was 64.3%, which was also higher than that of the non-anticoagulation group; however, this was not significantly different (χ2 = 3.938, P = 0.096). The presence of hepatic encephalopathy, serum bilirubin and albumin levels were major prognostic factors for Gynura segetum-induced HVOD. Anticoagulation therapy significantly increased the cure rate; however, TIPS treatment did not have a beneficial effect on the cure rate.
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