Clinical features of sinusoidal obstruction syndrome induced by pyrrolidine alkaloids in China

Objective To investigate the clinical manifestations, treatment, and prognosis of sinusoidal obstruction syndrome induced by pyrrolidine alkaloids in China. Methods Related databases were searched, and 107 articles on sinusoidal obstruction syndrome published from January 1980 to April 2017 in China were included, with 407 patients in total. Related data of this disease were analyzed, including sex, age, regional distribution, clinical manifestations, imaging and pathological findings, and prognosis. Results The male/female ratio of 407 patients was 1: 1. 22, and the age of onset ranged from 13 months to 81 years. Major clinical manifestations included abdominal distension, abdominal pain, ascites, and hepatomegaly. The most typical abdominal CT findings were hepatomegaly and a map-like or patchy change after enhancement. Pathological examination showed sinusoidal expansion and congestion and varying degrees of stenosis of small hepatic veins. Of all 407 patients, 302 had response and 90 died, resulting in a mortality rate of 22. 1%. Conclusion In China, the male population has a higher incidence rate of sinusoidal obstruction syndrome than the female population, and sinusoidal obstruction syndrome can occur at any age. Major clinical manifestations include abdominal distension, abdominal pain, ascites, and hepatomegaly, which can be used to make a definite diagnosis in combination with typical liver CT manifestations. Pathological findings by liver biopsy are the gold standard for diagnosis. Symptomatic treatment is the major treatment modality, and some patients may have poor prognosis.