Rongngern Pasinee, Chularojanamontri Leena, Wongpraparut Chanisada, Silpa-Archa Narumol, Chotiyaputta Watcharasak, Pongpaibul Ananya, Charatcharoenwitthaya Phunchai
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Wang Lang Road, Siriraj, Bangkok Noi, Bangkok, 10700, Thailand.
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Wang Lang Road, Siriraj, Bangkok Noi, Bangkok, Thailand.
Arch Dermatol Res. 2017 Jul;309(5):403-408. doi: 10.1007/s00403-017-1733-4. Epub 2017 Mar 16.
Liver biopsy, the gold standard for monitoring methotrexate-induced liver fibrosis in psoriasis patients, has potential morbidity and mortality. Transient elastography (TE) has been widely used as an alternative non-invasive method. Currently, psoriasis-specific data of TE comparing to Roenigk histopathology is lacking. This retrospective study assessed the diagnostic performance of TE in the detection of methotrexate-induced liver injury and liver fibrosis in Asian psoriasis patients. Risk factors that associated with liver injury by TE and histopathology were also determined. Psoriasis patients who had received methotrexate and undergone both TE and liver biopsy (gold standard) examinations between 2005 and 2016 were enrolled. Ten of 41 patients developed methotrexate-induced liver injury (Roenigk grade ≥3a) and two of them had significant liver fibrosis (Metavir fibrosis stage ≥2). Area under the receiver operating characteristic curve (AUROC = 0.78) indicated that TE was capable of identifying patients with and without liver injury. Using a cut-off TE value of 7.1 kilopascal (kPa), this ultrasound-based elastography yielded 50% sensitivity and 83.9% specificity for detecting methotrexate-induced liver injury and had 50% sensitivity and 76.9% specificity for identifying significant liver fibrosis. A total cumulative dosage of methotrexate, age, gender, metabolic syndrome, and metabolic components were not significantly associated with TE values ≥7.1 kPa and Roenigk grade ≥3a. Thus, using clinical context, laboratory information, and a cut-off TE value of 7.1, TE is an attractable non-invasive tool for identify psoriasis patients who have a low probability of methotrexate-induced liver injury and significant liver fibrosis. Liver biopsy can be reserved for selected patients.
肝活检是监测银屑病患者甲氨蝶呤诱导性肝纤维化的金标准，但存在潜在的发病率和死亡率。瞬时弹性成像（TE）已被广泛用作一种替代性的非侵入性方法。目前，缺乏与罗尼格克组织病理学相比的TE的银屑病特异性数据。这项回顾性研究评估了TE在检测亚洲银屑病患者甲氨蝶呤诱导性肝损伤和肝纤维化方面的诊断性能。还确定了与TE和组织病理学相关的肝损伤危险因素。纳入了2005年至2016年间接受过甲氨蝶呤治疗并接受过TE和肝活检（金标准）检查的银屑病患者。41名患者中有10名发生了甲氨蝶呤诱导性肝损伤（罗尼格克分级≥3a），其中2名有显著肝纤维化（梅塔维纤维化分期≥2）。受试者操作特征曲线下面积（AUROC = 0.78）表明，TE能够识别有无肝损伤的患者。使用7.1千帕（kPa）的TE临界值，这种基于超声的弹性成像检测甲氨蝶呤诱导性肝损伤的灵敏度为50%，特异性为83.9%，识别显著肝纤维化的灵敏度为50%，特异性为76.9%。甲氨蝶呤的总累积剂量、年龄、性别、代谢综合征和代谢成分与TE值≥7.1 kPa和罗尼格克分级≥3a无显著相关性。因此，结合临床情况、实验室信息以及7.1的TE临界值，TE是一种有吸引力的非侵入性工具，可用于识别甲氨蝶呤诱导性肝损伤和显著肝纤维化可能性较低的银屑病患者。肝活检可保留给选定的患者。
