Monitoring methotrexate-induced hepatic fibrosis in patients with psoriasis: are serial liver biopsies justified?
Monitoring methotrexate-induced hepatic fibrosis in patients with psoriasis: are serial liver biopsies justified?
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DOI：
10.1046/j.1365-2036.2004.01819.x
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发表时间：
2004-02-15
影响因子：
7.6
通讯作者：
Record, CO
中科院分区：
文献类型：
--
作者：
Aithal, GP;Haugk, B;Record, CO
背景：据报道，高达26%的银屑病患者发生肝硬化，因此建议在每次累计剂量1500mg甲氨蝶呤后进行连续肝活检。目的：探讨银屑病患者肝损伤的进展及肝活检监测对治疗的影响。方法：对66例牛皮癣患者（年龄11-79岁）的121例肝脏活检进行评估，这些患者接受中位累积剂量为3206 mg甲氨蝶呤，持续280.5周。结果：Ishak评分（≥4分）与Scheuer评分（≥3分）的相关性较好，与Roenigk评分（≥3b分）的相关性较差（r(2)分别= 1.0和0.31）。24例治疗前活检中有2例显示晚期纤维化，两名受试者都是重度饮酒者。累积剂量为1500、3000、4500、5000和6000 mg时，晚期纤维化的累积概率（Ishak大于或等于4）分别为0%、2.6%、2.6%、8.2%和8.2%。在随访期间没有受试者出现肝硬化或根据肝活检结果停止治疗。结论：低剂量甲氨蝶呤治疗晚期肝纤维化的发生率远低于先前报道。按照现行指南进行预处理或肝活检监测对患者管理影响不大。
Background: Reports that up to 26% of subjects with psoriasis develop cirrhosis have led to a recommendation of serial liver biopsies after each cumulative dose of 1500 mg of methotrexate.Aim: To evaluate the progression of liver injury in patients with psoriasis and the impact of monitoring by liver biopsy on their management.Methods: One hundred and twenty-one liver biopsies from 66 subjects (aged 11-79 years) with psoriasis, receiving a median cumulative dose of 3206 mg of methotrexate over a period of 280.5 weeks, were evaluated.Results: The assessment of advanced fibrosis according to the Ishak system (greater than or equal to 4) correlated perfectly with that of the Scheuer system (greater than or equal to 3) and poorly with that of the Roenigk scale (greater than or equal to 3b) (r(2) = 1.0 and 0.31, respectively). Two of 24 pre-treatment biopsies showed advanced fibrosis and both subjects were heavy drinkers. The cumulative probabilities of advanced fibrosis (Ishak greater than or equal to 4) were 0%, 2.6%, 2.6%, 8.2% and 8.2% at cumulative doses of 1500, 3000, 4500, 5000 and 6000 mg, respectively. None of the subjects developed cirrhosis during follow-up or discontinued therapy on the basis of liver biopsy findings.Conclusions: Advanced hepatic fibrosis with low-dose methotrexate therapy is much less frequent than previously reported. Pre-treatment or monitoring liver biopsies in accordance with the current guidelines have little impact on patient management.