Servicio de Aparato Digestivo y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
Med Clin (Barc). 2011 Nov 26;137(14):637-9. doi: 10.1016/j.medcli.2010.12.024. Epub 2011 Jun 29.
Methotrexate (MTX) safety is questioned by the risk of inducing liver fibrosis (LF). As transient elastography (FibroScan®) is an effective non-invasive technique to evaluate LF, our aims were to assess LF in MTX-treated patients, to evaluate LF regarding treatment duration and cumulative dose, and to determine differences depending on the underlying disease.
Prospective study including patients with rheumatoid arthritis, inflammatory bowel disease, and psoriasis treated with MTX. Hepatic stiffness was determined by FibroScan®. The LF cut-off values were established using METAVIR score.
Of 53 patients, 22 were men (41.5%), mean age was 55 (15) years, 17 (32%) had rheumatoid arthritis, 18 (34%) inflammatory bowel disease, and 18 (34%) psoriasis. Mean MTX cumulative dose was 1,805 (1,560) mg, and mean treatment duration was 178 weeks. Mean hepatic stiffness was 6.19 (2.43) KPa. In 49 patients (92.5%), absence/mild LF was found (F ≤ 2), and 4 patients (7.5%) had advanced LF (F ≥ 3). Treatment duration or cumulative doses of MTX were not associated with LF.
Regarding LF development, MTX therapy is safe. FibroScan® is useful for monitoring LF in MTX-treated patients.
甲氨蝶呤（MTX）的安全性受到诱导肝纤维化（LF）风险的质疑。由于瞬时弹性成像（FibroScan®）是评估 LF 的有效非侵入性技术，我们的目的是评估 MTX 治疗患者的 LF，评估 LF 与治疗持续时间和累积剂量的关系，并确定与基础疾病相关的差异。
这项前瞻性研究纳入了接受 MTX 治疗的类风湿关节炎、炎症性肠病和银屑病患者。通过 FibroScan®测定肝硬度。采用 METAVIR 评分确定 LF 的截断值。
53 例患者中，22 例为男性（41.5%），平均年龄为 55（15）岁，17 例（32%）患有类风湿关节炎，18 例（34%）患有炎症性肠病，18 例（34%）患有银屑病。MTX 累积剂量的平均值为 1805（1560）mg，治疗持续时间的平均值为 178 周。平均肝硬度为 6.19（2.43）kPa。在 49 例（92.5%）患者中，未见或轻度 LF（F ≤ 2），4 例（7.5%）患者存在进展性 LF（F ≥ 3）。MTX 治疗的持续时间或累积剂量与 LF 无关。
就 LF 发展而言，MTX 治疗是安全的。FibroScan®可用于监测 MTX 治疗患者的 LF。
