Newman M, Auerbach R, Feiner H, Holzman R S, Shupack J, Migdal P, Culubret M, Camuto P, Tobias H
Department of Medicine, New York University Medical Center, New York.
Arch Dermatol. 1989 Sep;125(9):1218-24.
Liver biopsy specimens from 168 patients who underwent a total of 364 biopsies were examined. Of 83 patients receiving biopsies before methotrexate treatment, 14 had one or more risk factors predictive of liver abnormality but they had normal pretreatment biopsy specimens. Among 17 patients with abnormal biopsy specimens before methotrexate treatment, only 1 had an identifiable risk factor and 5 had abnormal results of liver function tests. The probability of a normal biopsy specimen after methotrexate treatment dropped below 50% at a cumulative methotrexate dose of 3115 mg for the 31 patients with biopsy specimens from before and after methotrexate treatment and 5776 mg for those who had biopsies only after methotrexate treatment; this difference was statistically significant and is thought to be related to the fact that the patients who had biopsies before and after methotrexate treatment had received most of their medication by the parenteral rather than the oral route. A significant association existed between biopsy grade after methotrexate treatment and obesity. Other risk factors were not correlated with biopsy grade. Blood chemistry tests were not predictive of histopathologic findings. Eight of 11 patients with fibrosis or cirrhosis showed meaningful improvement in liver histologic findings after methotrexate treatment had been withdrawn for 6 months or more; none had progression of abnormalities.
对168例患者的肝脏活检标本进行了检查，这些患者共接受了364次活检。在83例接受甲氨蝶呤治疗前活检的患者中，14例有一项或多项预测肝脏异常的危险因素，但他们治疗前的活检标本正常。在17例甲氨蝶呤治疗前活检标本异常的患者中，只有1例有可识别的危险因素，5例肝功能检查结果异常。对于31例有甲氨蝶呤治疗前后活检标本的患者，甲氨蝶呤累积剂量达到3115 mg时，治疗后活检标本正常的概率降至50%以下；对于仅在甲氨蝶呤治疗后进行活检的患者，该剂量为5776 mg；这种差异具有统计学意义，被认为与甲氨蝶呤治疗前后均进行活检的患者大多通过胃肠外而非口服途径给药这一事实有关。甲氨蝶呤治疗后的活检分级与肥胖之间存在显著关联。其他危险因素与活检分级无关。血液化学检查不能预测组织病理学结果。11例纤维化或肝硬化患者中有8例在停用甲氨蝶呤治疗6个月或更长时间后，肝脏组织学检查结果有明显改善；无一例出现异常进展。
