ILD care team, Department of Pathology, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
Eur J Gastroenterol Hepatol. 2012 Jan;24(1):17-24. doi: 10.1097/MEG.0b013e32834c7b71.
Sarcoidosis is a multisystemic inflammatory granulomatous disease. The prevalence of hepatic involvement is not clear.
The aim of this study was to establish the presence and severity of the liver-test abnormalities in sarcoidosis.
Retrospectively, patients with confirmed sarcoidosis (n=837) presented with the liver-test abnormalities [alkaline phosphatase, γ-glutamyl transaminase, alanine aminotransferase or aspartate aminotransferase >1.5 times the upper limit of normal (ULN)] who were classified according to severity into mild (zero liver tests ≥3×ULN), moderate (one or two liver tests ≥3×ULN) and severe (three or four liver tests ≥3×ULN) were evaluated. Moreover, the relationship between severity of liver tests and histology was examined.
Liver-test abnormalities were found in 204 of 837 patients with chronic sarcoidosis (24.4%), among which 127 (15.2%) were suspected of having hepatic sarcoidosis (79 of 127 males, 111 Caucasian, eight African-American). In 22 of 127 patients (17.3%), a liver biopsy was obtained; 21 were compatible with hepatic sarcoidosis. In these 21 patients, severity of liver-test abnormalities was significantly associated with extensiveness of granulomatous inflammation (ρ=0.58, P=0.006) and degree of fibrosis (ρ=0.64, P=0.002). These results remained in the multiple regression analysis when controlled for treatment status, sex, genetics, ethnicity and age.
Liver-test abnormalities were present in 24% of the studied patients; in 15% highly because of hepatic involvement of sarcoidosis. Moderate and severe liver-test abnormalities seemed to be associated with more advanced histopathological disease. Therefore, in the management of sarcoidosis, for patients with moderate or severe liver-test abnormalities a liver biopsy is recommended.
结节病是一种多系统炎症性肉芽肿性疾病。肝受累的患病率尚不清楚。
本研究旨在确定结节病患者肝脏试验异常的存在和严重程度。
回顾性分析 837 例确诊为结节病（n=837）且伴有肝脏试验异常[碱性磷酸酶、γ-谷氨酰转移酶、丙氨酸氨基转移酶或天冬氨酸氨基转移酶＞正常值上限（ULN）的 1.5 倍]的患者。根据严重程度分为轻度（零项肝脏试验≥3×ULN）、中度（一项或两项肝脏试验≥3×ULN）和重度（三项或四项肝脏试验≥3×ULN）。此外，还检查了肝脏试验严重程度与组织学之间的关系。
837 例慢性结节病患者中有 204 例（24.4%）存在肝脏试验异常，其中 127 例（15.2%）疑似患有肝结节病（79 例为男性，111 例为白种人，8 例为非裔美国人）。在 127 例患者中有 22 例（17.3%）获得了肝脏活检，其中 21 例与肝结节病相符。在这 21 例患者中，肝脏试验异常的严重程度与肉芽肿性炎症的广泛性（ρ=0.58，P=0.006）和纤维化程度（ρ=0.64，P=0.002）显著相关。当控制治疗状态、性别、遗传、种族和年龄后，这些结果仍保留在多元回归分析中。
在研究的患者中，24%存在肝脏试验异常；其中 15%高度因为结节病的肝受累。中度和重度肝脏试验异常似乎与更严重的组织病理学疾病相关。因此，在结节病的管理中，对于存在中度或重度肝脏试验异常的患者，建议进行肝脏活检。
