Barbero-Villares A, Mendoza Jiménez-Ridruejo J, Taxonera C, López-Sanromán A, Pajares R, Bermejo F, Pérez-Calle J L, Mendoza J L, Algaba A, Moreno-Otero R, Maté J, Gisbert J P
Instituto de Investigación Sanitaria Princesa-IP and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas-CIBEREHD, Universitario de La Princesa, Gastroenterology Units of the Hospitals, Madrid, Spain.
Scand J Gastroenterol. 2012 May;47(5):575-9. doi: 10.3109/00365521.2011.647412. Epub 2012 Jan 10.
Methotrexate is an effective treatment for inflammatory bowel disease (IBD). However, long-term treatments have been associated with the development of liver fibrosis. FibroScan® is a noninvasive, safe, and effective technique to evaluate liver fibrosis.
To evaluate the presence of significant liver fibrosis by transient elastography (FibroScan®) in IBD patients treated with methotrexate.
Cross-sectional study including IBD patients treated with methotrexate from different hospitals. Clinical and analytical data, duration of treatment, and cumulative dose of methotrexate were obtained. Liver stiffness was assessed by FibroScan®. The cutoff value for significant liver fibrosis (according to METAVIR) was F ≥ 2: 7.1 kPa. Results. In the study, 46 patients were included, 30 women (65%), with a mean age of 43 ± 10 years. 31 patients had Crohn's disease (67.4%), 13 ulcerative colitis (28.3%), and 2 indeterminate colitis (4.3%). The mean cumulative dose of methotrexate was 1242 ± 1349 mg, with a mean treatment duration of 21 ± 24 months. The mean value of liver stiffness was 4.7 ± 6.9 kPa. There were 35 patients (76.1%) with F01, 8 patients (17.4%) with F = 2, and 3 patients with F ≥ 3 (6.5%). There were no differences in liver stiffness depending on sex, age, type of IBD, or cumulative dose of methotrexate.
(1) Development of advanced liver fibrosis in IBD patients treated with methotrexate is exceptional. (2) There were no differences in liver stiffness depending on the type of IBD or the cumulative dose of methotrexate. (3) FibroScan® may be potentially useful for evaluation and follow-up of liver fibrosis in methotrexate-treated patients.
甲氨蝶呤是治疗炎症性肠病（IBD）的有效药物。然而，长期治疗与肝纤维化的发生有关。FibroScan®是一种评估肝纤维化的非侵入性、安全且有效的技术。
通过瞬时弹性成像（FibroScan®）评估接受甲氨蝶呤治疗的IBD患者中显著肝纤维化的存在情况。
对来自不同医院接受甲氨蝶呤治疗的IBD患者进行横断面研究。获取临床和分析数据、治疗持续时间以及甲氨蝶呤的累积剂量。通过FibroScan®评估肝脏硬度。显著肝纤维化的截断值（根据METAVIR标准）为F≥2：7.1 kPa。结果。本研究纳入46例患者，其中30例为女性（65%），平均年龄为43±10岁。31例患有克罗恩病（67.4%），13例患有溃疡性结肠炎（28.3%），2例患有不确定性结肠炎（4.3%）。甲氨蝶呤的平均累积剂量为1242±1349 mg，平均治疗持续时间为21±24个月。肝脏硬度的平均值为4.7±6.9 kPa。F0-1级的患者有35例（76.1%），F = 2级的患者有8例（17.4%），F≥3级的患者有3例（6.5%）。根据性别、年龄、IBD类型或甲氨蝶呤的累积剂量，肝脏硬度无差异。
（1）接受甲氨蝶呤治疗的IBD患者中晚期肝纤维化的发生情况罕见。（2）根据IBD类型或甲氨蝶呤的累积剂量，肝脏硬度无差异。（3）FibroScan®可能对评估和随访接受甲氨蝶呤治疗患者中的肝纤维化有潜在作用。
