Shetty Akshay, Cho WonKyung, Alazawi William, Syn Wing-Kin
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina.
Department of Hepatology, Barts Health NHS Trust, London, United Kingdom; Centre for Immunobiology, Blizzard Institute, Queen Mary University of London, London, United Kingdom.
Am J Med Sci. 2017 Aug;354(2):172-181. doi: 10.1016/j.amjms.2017.03.014. Epub 2017 Mar 14.
Methotrexate (MTX) is commonly used to treat individuals with rheumatological and dermatologic disorders. Current American College of Rheumatology (ACR) and American Association of Dermatology (AAD) guidelines identify diabetes and obesity as risk factors for MTX-induced liver injury. Both diabetes and obesity are components of the metabolic syndrome, and are also risk factors for nonalcoholic fatty liver disease (NAFLD). NAFLD affects approximately 40% of the U.S. population, and those with more advanced NAFLD (i.e., nonalcoholic steatohepatitis with or without fibrosis) are likely to develop progressive liver disease. As such, individuals who are treated with MTX may need to be screened for advanced NAFLD, as this may put them at an increased risk of MTX-induced liver injury. In this mini-review, we review the current ACR and AAD guidelines on MTX hepatotoxicity, discuss the evidence (or lack thereof) of the impact of metabolic risk factors on MTX-induced liver injury and highlight the areas that need further research.
甲氨蝶呤（MTX）常用于治疗患有风湿性和皮肤病的个体。美国风湿病学会（ACR）和美国皮肤病学会（AAD）目前的指南将糖尿病和肥胖确定为MTX诱导肝损伤的风险因素。糖尿病和肥胖都是代谢综合征的组成部分，也是非酒精性脂肪性肝病（NAFLD）的风险因素。NAFLD影响着约40%的美国人口，而那些患有更晚期NAFLD（即伴有或不伴有纤维化的非酒精性脂肪性肝炎）的人很可能会发展为进行性肝病。因此，接受MTX治疗的个体可能需要接受晚期NAFLD筛查，因为这可能会使他们面临MTX诱导肝损伤的风险增加。在本综述中，我们回顾了ACR和AAD目前关于MTX肝毒性的指南，讨论了代谢风险因素对MTX诱导肝损伤影响的证据（或缺乏证据），并强调了需要进一步研究的领域。
