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奥沙利铂所致肝窦阻塞综合征的多维度临床评估与转归分析
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| 篇名： | 奥沙利铂所致肝窦阻塞综合征的多维度临床评估与转归分析 |
| TITLE： | Multidimensional clinical assessment and outcome analysis of oxaliplatin-induced hepatic sinusoidal obstruction syndrome |
| 摘要： | 目的 提高临床对奥沙利铂所致肝窦阻塞综合征（HSOS）的识别与管理水平。方法对PubMed、WebofScience、Embase、中国知网、维普网、万方医学数据库进行系统检索，收集奥沙利铂所致HSOS病例，同时纳入苏州大学附属第四医院（简称“本院”）收治的典型病例，系统分析奥沙利铂所致HSOS的临床特征、实验室检查指标、影像学表现、治疗及预后等，并按化疗方案和患者性别进行亚组分析。结果共收集到32例奥沙利铂所致HSOS病例（文献31例、本院1例）。其中，男、女各16例，中位年龄58.5岁，中位发病时间为168d。最常见的实验室检查异常为碱性磷酸酶（ALP）/γ-谷氨酰转移酶（GGT）升高（占报告病例的69.2%，9/13），部分患者伴转氨酶升高及血小板减少。影像学表现包括脾肿大（37.5%，12/32）、肝内低密度灶（28.1%，9/32）及门脉高压征象（21.9%，7/32）等。治疗以停用奥沙利铂为主，辅以对症支持治疗或肝切除术，患者总体好转率为84.0%（21/25）。亚组分析结果显示，在使用FOLFOX方案的患者中，有36.8%的患者在168d内出现症状，显著低于使用其他方案的患者占比（83.3%）（P＜0.0125）。结论奥沙利铂所致HSOS常表现为ALP/GGT升高与脾肿大，影像学上的低密度灶是鉴别诊断的重点，停药并对症支持治疗后多数患者病情改善。临床应重视早期识别该并发症，密切监测患者肝功能和影像学变化。 |
| ABSTRACT： | OBJECTIVE To improve the clinical recognition and management of oxaliplatin-induced hepatic sinusoidal obstruction syndrome （HSOS）.METHODS A systematic search was conducted in PubMed， Web of Science， Embase， CNKI， VIP， and Wanfang Medical Database to collect cases of oxaliplatin-induced HSOS. Typical cases admitted to the Fourth Affiliated Hospital of Soochow University （hereinafter referred to as “our hospital”） were also included. The clinical characteristics， laboratory findings， imaging manifestations， treatment， and prognosis of oxaliplatin-induced HSOS were systematically analyzed， and subgroup analyses were performed according to chemotherapy regimen and patient sex.RESULTS A total of 32 cases of oxaliplatin-induced HSOS were collected （31 from the literature and 1 from our hospital）. Among them， there were 16 males and 16 females， with a median age of 58.5 years and a median time to onset of 168 days. The most common laboratory abnormality was elevated alkaline phosphatase （ALP）/ γ -glutamyl transferase （GGT） （accounting for 69.2% of reported cases， 9/13）， and some patients had elevated transaminases and thrombocytopenia. Imaging findings included splenomegaly （37.5%， 12/32）， intrahepatic hypodense lesions （28.1%， 9/32）， signs of portal hypertension （21.9%， 7/32）， etc. Treatment mainly consisted of discontinuation of oxaliplatin， supplemented with symptomatic supportive treatment or liver resection. The overall improvement rate of patients was 84.0% （21/25）. Subgroup analysis showed that among patients receiving the FOLFOX regimen， 36.8% developed symptoms within 168 days， which was significantly lower than the proportion of patients receiving other regimens （83.3%） （ P ＜0.012 5）.CONCLUSIONS Oxaliplatin-induced HSOS often presents with elevated ALP/GGT and splenomegaly. Hypodense lesions on imaging are a key point in differential diagnosis. Most patients improve after discontinuation of oxaliplatin and symptomatic supportive treatment. Clinically， emphasis should be placed on early recognition of this complication and close monitoring of liver function and imaging changes. |
| 期刊： | 2026年第37卷第19期 |
| 作者： | 洪华东；包健安；马晶晶 |
| AUTHORS： | HONG Huadong，BAO Jian’an，MA Jingjing |
| 关键字： | 奥沙利铂;肝窦阻塞综合征;肝窦扩张;药物不良反应;药源性疾病 |
| KEYWORDS： | Oxaliplatin;hepatic sinusoidal obstruction syndrome;hepatic sinusoidal dilatation;Adverse drug reaction;drug-induced disease |
| 阅读数： | 2 次 |
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