Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box Number 356424, Seattle, WA 98195, USA.
Clin Liver Dis. 2011 Feb;15(1):153-64. doi: 10.1016/j.cld.2010.09.006.
Rheumatologic diseases such as rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, and scleroderma are immunologically mediated disorders that typically have multisystem involvement. Although clinically significant liver involvement is rare, liver enzyme abnormalities may be observed in up to 43% of patients. The biochemical abnormalities are typically mild and transient and the histologic abnormalities are usually nonprogressive. Such biochemical and histologic findings are typically ascribed to the primary rheumatologic condition and require no specific management. In a subset of patients with rheumatologic conditions and liver test abnormalities, further evaluation identifies a coexisting, primary liver disease or medication-related liver toxicity as the cause of the biochemical abnormality. Liver test abnormalities in patients with a coexisting primary liver disease are more likely to be persistent. In such cases, further workup using serologic tests, appropriate imaging studies and liver biopsy may be needed to accurately identify the cause of liver test abnormalities. This article reviews the spectrum of liver-related abnormalities associated with several rheumatologic diseases. Hepatotoxicity related to medications commonly prescribed in such conditions is also discussed.
风湿性疾病，如类风湿关节炎、系统性红斑狼疮、干燥综合征和硬皮病，是免疫介导的疾病，通常涉及多系统。尽管临床上显著的肝脏受累很少见，但高达 43%的患者可能出现肝酶异常。生化异常通常是轻微和短暂的，组织学异常通常是不可进展的。这些生化和组织学发现通常归因于原发性风湿性疾病，不需要特定的治疗。在一部分患有风湿性疾病和肝试验异常的患者中，进一步评估确定共存的原发性肝脏疾病或与药物相关的肝毒性是生化异常的原因。伴有共存原发性肝脏疾病的患者的肝试验异常更可能持续存在。在这种情况下，可能需要使用血清学检测、适当的影像学研究和肝活检进一步检查，以准确确定肝试验异常的原因。本文综述了与几种风湿性疾病相关的一系列肝脏相关异常。还讨论了与这些情况下常用的药物相关的肝毒性。
