Khan S, Subedi D, Chowdhury M M U
Department of Immunopathology, St Bartholomew's Hospital, London, UK.
Postgrad Med J. 2006 May;82(967):353-4. doi: 10.1136/pgmj.2005.041533.
Hepatic fibrosis continues to be a risk in patients receiving methotrexate for psoriasis. Measurement of amino terminal levels of type III procollagen (P3NP) has been advocated as an effective non-invasive test for ongoing hepatic fibrogenesis that could avoid liver biopsies. An audit was conducted to assess the practice of P3NP monitoring using guidelines produced by Manchester and whether the agreed levels correlate with histological severity. Sixty five patients with 174 P3NP assays and 30 liver biopsies were reviewed between the years 1999 and 2003. Total number of patient-methotrexate years was 278.9 and the mean cumulative dose of methotrexate received was 2000 (SD 1838) mg. A higher cumulative dose of methotrexate correlated significantly with high mean and maximum P3NP levels. Of the 30 liver biopsies, 26 (86.6%) showed normal histology or mild to moderate steatosis, three had focal fibrosis, and one had early cirrhosis. A median P3NP value of 5.8 mug/l or higher had a stronger correlation with histological severity. It is concluded that P3NP assay is a valuable adjunct to the clinical management of patients receiving long term methotrexate that can avoid or reduce unnecessary liver biopsies.
对于接受甲氨蝶呤治疗银屑病的患者而言，肝纤维化仍是一个风险因素。III型前胶原氨基端水平（P3NP）的测定被推荐作为一种有效的非侵入性检测方法，用于监测持续的肝纤维化形成，从而避免肝脏活检。我们进行了一项审核，以评估采用曼彻斯特制定的指南进行P3NP监测的实际情况，以及所商定的水平是否与组织学严重程度相关。在1999年至2003年期间，对65例患者进行了174次P3NP检测和30次肝脏活检。患者接受甲氨蝶呤治疗的总年数为278.9年，接受甲氨蝶呤的平均累积剂量为2000（标准差1838）mg。甲氨蝶呤的累积剂量越高，与P3NP的平均水平和最高水平显著相关。在30次肝脏活检中，26例（86.6%）显示组织学正常或轻度至中度脂肪变性，3例有局灶性纤维化，1例有早期肝硬化。P3NP值中位数为5.8μg/l或更高与组织学严重程度的相关性更强。结论是，P3NP检测对于接受长期甲氨蝶呤治疗的患者的临床管理是一种有价值的辅助手段，可避免或减少不必要的肝脏活检。
