Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome: Pathogenesis, clinical manifestations, diagnosis,treatment, and outcomes

Xiao-Qian Yang; Jin Ye; Xin Li; Qian Li; Yu-Hu Song

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Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome: Pathogenesis, clinical manifestations, diagnosis,treatment, and outcomes

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Hepatic sinusoidal obstruction syndrome (HSOS) can be caused by the intake of pyrrolizidine alkaloids (PAs). To date, PAs-induced HSOS has not been extensively studied. In view of the difference in etiology of HSOS between the West and China, clinical profiles, imaging findings, treatment, and outcomes of HSOS associated with hematopoietic stem cell transplantation or oxaliplatin might be hardly extrapolated to PAs-induced HSOS. Reactive metabolites derived from PAs form pyrrole-protein adducts that result in toxic destruction of hepatic sinusoidal endothelial cells. PAs-induced HSOS typically manifests as painful hepatomegaly, ascites, and jaundice. Laboratory tests revealed abnormal liver function tests were observed in most of the patients with PAs-induced HSOS. In addition, contrast computed tomography and magnetic resonance imaging scan show that patients with PAs-induced HSOS have distinct imaging features, which reveal that radiological imaging provides an effective noninvasive method for the diagnosis of PAs-induced HSOS. Liver biopsy and histological examination showed that PAs-induced HSOS displayed distinct features in acute and chronic stages. Therapeutic strategies for PAs-induced HSOS include rigorous fluid management, anticoagulant therapy, glucocorticoids, transjugular intrahepatic portosystemic shunt, liver transplantation, etc. The aim of this review is to describe the pathogenesis, clinical profiles, diagnostic criteria, treatment, and outcomes of PAs-induced HSOS.

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《世界胃肠病学杂志：英文版》 |2019年第28期|3753-3763|共11页
作者
Xiao-Qian Yang; Jin Ye; Xin Li; Qian Li; Yu-Hu Song;
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作者单位

Division of Gastroenterology;

Union Hospital;

Tongji Medical college;

Huazhong University of Science and Technology;

Wuhan 430022;

Hubei Province;

China;

Department of Radiology;

Union Hospital;

Tongji Medical college;

Huazhong University of Science and technology;

Wuhan 430022;

Hubei Province;

China;

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原文格式 PDF
正文语种 chi
中图分类医药、卫生;
关键词
Hepatic; sinusoidal; obstruction; syndrome; Pyrrolizidine; alkaloids; Hepatic; sinusoidal; endothelial; cells; Pyrrole-protein; adducts; Diagnostic; criteria; Symptomatic; treatment; Anticoagulant; therapy;

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Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome: Pathogenesis, clinical manifestations, diagnosis,treatment, and outcomes

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