Pengcheng Ou, Xinyu Liu, Zhiqun Tang, Zhouhua Hou, Li Liu, Jun Liu, Shangchen Zhou, Zhixiong Fang, Kewei Sun, Yue Chen, Xiaobei Chen, Yi Li* and Jun Chen* Pages 3762 - 3768 ( 7 )
Background and Aim: Gynura segetum (Tusanqi or Jusanqi) is widely used in China as a herbal remedy, however, it has often been associated with hepatic sinusoidal obstruction syndrome (HSOS). Its extent in inducing hepatotoxicity is not sufficiently understood. Hence, we aimed to identify the characteristic features of Gynura segetum associated HSOS.
Methods: A total of 64 patients diagnosed with HSOS induced by gynura segetum were enrolled from eight Chinese tertiary care hospitals between 2008 and 2018. General information regarding diagnosis, disease history, suspected drug use, symptoms and signs, biochemical index, imaging data, liver histology, treatment methods, severity and prognosis were collected and analyzed.
Results: The mean age of the enrolled patients were 58.07±11.44 years. Male patients accounted for 64.1% of HSOS patients. The median latency period was 75 days. The number of patients with a definite diagnosis from the eight hospitals was 5 (7.81%), with a misdiagnosis rate of 92.18%. Hepatomegaly, splenomegaly, ascites and lower limbs edema were present in 89.1%, 76.6%, 81.3% and 43.8% of the patients, respectively. The imaging characteristic changes were liver parenchyma echo thickening, uneven density, and hepatic vein stenosis and occlusion. Liver biopsies had characteristic pathological changes. Except for ALT and D-Dimer, liver function and coagulation index at admission and before discharge were not significantly different (p>0.05). The 6-month mortality rate was 77.55%, with upper-gastrointestinal bleeding being the leading cause of death (42.11%). The second leading cause of death was a secondary infection (36.84%), while the third was hepatorenal syndrome (21.05%).
Conclusion: Gynura segetum related HSOS often presents as progressive hepatic congestion, portal hypertension and liver failure, and has a high mortality and misdiagnosis rate.
Gynura segetum, hepatic sinusoidal obstruction syndrome (HSOS), Chinese herbal medicine, DILI, hepatomegaly, splenomegaly.
Department of Infectious Diseases, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, 518020, Department of Infectious Diseases, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410000, Department of Internal Medicine, The Third People's Hospital of Shenzhen, the Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, 518100, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, Department of Infectious Diseases, Hunan Provincial People's Hospital, Changsha, Hunan, 410000, Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, Liver Diseases Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, Department of Infectious Diseases, The Central Hospital of Xiangtan, Xiangtan, Hunan, 411100, Department of Infectious Diseases, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410007, Department of Infectious Diseases, Taihe Hospital, Shiyan, Hubei, 442008, Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, Liver Diseases Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, Department of Liver Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, 518100