Parisi Ioanna, O'Beirne James, Rossi Roberta E, Tsochatzis Emmanuel, Manousou Pinelopi, Theocharidou Eleni, Hamilton Mark, Murray Charles, Epstein Owen, Burroughs Andrew K
aSheila Sherlock Liver Centre, Royal Free Hospital and UCL Institute of Liver and Digestive Health bDepartment of Gastroenterology, Royal Free Hospital, London, UK cDepartment of Gastroenterology, Theageneio Hospital, Thessaloniki, Greece dGastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
Eur J Gastroenterol Hepatol. 2016 Jul;28(7):786-91. doi: 10.1097/MEG.0000000000000624.
Abnormal liver enzymes are frequently encountered in inflammatory bowel disease (IBD) patients. Infliximab has been implicated in inducing drug-induced liver injury, autoimmune hepatitis or reactivation of hepatitis B virus. We aimed to clarify the role of infliximab in liver impairment in an IBD cohort.
A total of 305 patients with IBD, without evidence of chronic liver disease, were included in the study and retrospectively evaluated. Laboratory and clinical data were retrieved from a prospectively acquired database. In all, 176 consecutive patients treated with infliximab during the last 5 years were compared with a matched population of 129 patients who did not receive any antitumour necrosis factor treatment.
Elevation of alanine transaminase (ALT) was frequent in the entire population (36.4%) and it was not significantly associated with the use of infliximab (P=0.284). Elevations more than 3 upper limit of normal were observed in 7.9% and these resolved spontaneously in 83%. The use of immunomodulators was the only factor that was significantly associated with liver enzyme abnormalities in multivariate analysis [odds ratio (OR) 2.666, 95% confidence interval (CI) 1.576-4.511, P<0.005]. Overall, 39% of patients on infliximab had elevated liver enzymes and this was associated with increased ALT before starting infliximab (OR 3.854, 95% CI 1.800-8.251, P=0.001) and with longer duration of infliximab treatment (OR 1.030, 95% CI 1.013-1.047, P=0.001).
Elevated liver enzymes are frequently found in IBD patients and they usually resolve spontaneously. The use of immunomodulators was independently associated with increased ALT. Infliximab is relatively safe in terms of liver impairment and discontinuation of treatment is rarely required in the setting of modest elevations of ALT.
炎症性肠病（IBD）患者经常出现肝酶异常。英夫利昔单抗被认为可诱发药物性肝损伤、自身免疫性肝炎或乙型肝炎病毒再激活。我们旨在阐明英夫利昔单抗在IBD队列中肝损伤中的作用。
共有305例无慢性肝病证据的IBD患者纳入本研究并进行回顾性评估。实验室和临床数据来自前瞻性获取的数据库。总共将过去5年中连续接受英夫利昔单抗治疗的176例患者与129例未接受任何抗肿瘤坏死因子治疗的匹配人群进行比较。
整个研究人群中丙氨酸转氨酶（ALT）升高很常见（36.4%），且与英夫利昔单抗的使用无显著相关性（P=0.284）。7.9%的患者ALT升高超过正常上限的3倍，其中83%可自发缓解。在多变量分析中，免疫调节剂的使用是与肝酶异常显著相关的唯一因素[比值比（OR）2.666，95%置信区间（CI）1.576 - 4.511，P<0.005]。总体而言，39%接受英夫利昔单抗治疗的患者肝酶升高，这与开始使用英夫利昔单抗前ALT升高有关（OR 3.854，95% CI 1.800 - 8.251，P=0.001），也与英夫利昔单抗治疗时间延长有关（OR 1.030，95% CI 1.013 - 1.047，P=0.001）。
IBD患者中经常发现肝酶升高，且通常可自发缓解。免疫调节剂的使用与ALT升高独立相关。就肝损伤而言，英夫利昔单抗相对安全，在ALT轻度升高的情况下很少需要停药。
