Tu Sanqi Leads To Hepatic Sinus Blockage Syndrome: A Systematic Review Of Chinese Literature

Purpose: A systematic review aimed to evaluate the clinical profiles,diagnostic workup,treatment,and outcomes of tusanqi-related SOS in China.Material and method: All relevant papers were searched via Pub Med,China Knowledge Resource Integrated(CNKI),VIP,and Wanfang databases.Last search was performed on March 26,2015.All the included studies were performed for quality assessment.According to the ways of data expression,all included studies were divided into case reports and case series.In the case reports,the survival analysis was performed,the cumulative survival rate was obtained.Cox regression analysis was performed to evaluate the factors that were significantly associated with survival.Hazard ratios(HRs)with 95% confidence intervals(CIs)for every variable were calculated.In the case series,the meta-analyses were performed,the proportion of different clinical manifestations and tusanqi-related SOS in all patients with SOS secondary to mixed etiologies were calculated.Results: Overall,735 papers were retrieved.106 papers were eligible,including 56 case reports and 50 case series.Fifty-six case reports included 84 individual patients with SOS secondary to tusanqi alone.All of them presented with ascites,but only one patient presented with upper gastrointestinal bleeding.The 1-,3-,and 6-month cumulative survival rate was 98%,87%,and 76%,respectively.Increased bilirubin(HR = 1.024,95% CI = 1.003-1.045,P = 0.027)and aspartate transaminase(HR = 1.004,95% CI = 1.001-1.007,P = 0.005)levels were significantly associated with poor outcome.Thirty-one case series included 402 patients with SOS secondary to tusanqi alone.Ascites was observed in 94% of patients,hepatomegaly was observed in 89% of patients,but upper gastrointestinal bleeding was observed in 40% of patients.Recovery,stabilization,progression,and death were observed in 41%,30%,14%,and 16% of patients,respectively.Nineteen case series included 281 patients with SOS secondary to mixed etiologies.The pooled proportion of tusanqi-related SOS was 66%.Conclusion: Tusanqi is a major etiology of SOS in China.Ascites and hepatomegaly are two most common clinical presentation of tusanqi-related SOS.Despite a relatively good short-term outcome,further studies should be necessary to explore the long-term outcome and refine the treatment strategy.