Efficacy of transjugular intrahepatic portosystemic shunt in the treatment of 21 patients with gynura segetum-related hepatic sinusoidal obstruction syndrome

Objective To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of patients with hepatic sinusoidal obstruction syndrome (HSOS). Methods From April 2015 to August 2018, at The First Affiliated Hospital of University of Science and Technology of China, 21 patients with gynura segetum caused HSOS were selected. All the patients received TIPS treatment because of unresponsiveness to anticoagulant therapy for at least two weeks. After operation patients were followed up with liver and portal vein Doppler ultrasonography examination, liver and kidney function tests, and survival observation. T test, logistic univariate regression analysis and Cox regression analysis were performed for statistical analysis. Results Among the 21 patients with gynura segetum-related HSOS, 18 patients were in the subacute phase and three patients in the chronic phase. All of them were moderate or severe patients and all successfully underwent TIPS. The postoperative portal vein pressure was (16.71±4.68) cmH2O (1 cmH2O=0.098 kPa), which was lower than that before operation ((41.52±6.27) cmH2O), and the difference was statistically significant (t=16.936, P<0.01). The postoperation portal vein blood flow velocity was (41.52±7.70) cm/s, which was higher than before operation ((11.19±3.29) cm/s), and the difference was statistically significant (t=-15.191, P<0.01). At one month after operation, 15 of 21 patients were clinically cured; among the remaining six patients, four patients were improved and two patients were ineffective (including one patient died). At four months after operation, two patients died, and the remaining 19 patients were clinically cured. At one month after operation, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and serum creatinine were (23.7±16.8) U/L, (33.9±7.4) U/L, (52.7±38.2) μmol/L and (62.7±12.6) μmol/L, respectively, which were lower than those before operation ((60.5±42.4) U/L, (78.4±42.4) U/L, (74.9±38.2) μmol/L and (82.4±19.6) μmol/L, respectively), and the differences were statistically significant (t=3.193, 3.493, 2.378 and 4.519; all P<0.05). The level of albumin was (39.0±3.1) g/L, which was higher than that before operation ((30.9±3.8) g/L), and the difference was statistically significant (t=-10.283, P<0.01). Portal vein thrombosis and preoperative TBil level had predictive value for therapeutic efficacy (both P<0.05). The one-year cumulative survival rate of patients was 90.5%. Preoperative TBil level and hepatic encephalopathy had effects on the prognosis of patients (both P<0.05). Conclusion TIPS is a safe, reliable and effective treatment for patients with subacute and chronic gynura segetum-related HSOS who are not responding to ineffective anticoagulant therapy, which can improve the prognosis and survival rate of the patients. Key words: Hepatic veno-occlusive disease; Portasystemic shunt, transjugular intrahepatic; Survival rate; Gynura segetum; Pyrrolidine alkaloid; Liver sinusoidal endothelial cell