Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Dermatol Venereol Leprol. 2020 Sep-Oct;86(5):508-514. doi: 10.4103/ijdvl.IJDVL_425_19.
Long-term low-dose methotrexate therapy is associated with liver fibrosis. Although liver biopsy is the gold standard for detecting fibrosis, it is an invasive procedure associated with morbidity and mortality risks. Hence noninvasive imaging techniques such as transient elastography (TE) and shear wave elastography (SWE) have been studied to measure liver stiffness.
To assess the utility of TE and SWE in detecting fibrosis in patients with psoriasis and reactive arthritis on long-term methotrexate therapy.
A cross-sectional prospective study was undertaken on 54 patients with psoriasis and reactive arthritis who had received ≥1.5 g of methotrexate. Various clinical and biochemical [fibrosis 4 index (FIB4), aspartate-transaminase-to-platelet ratio index (APRI)] parameters were calculated and liver stiffness measurement (LSM) was done with TE and SWE. The degree of steatosis was measured using controlled attenuation parameter (CAP). Liver biopsy was done when indicated and was interpreted by a pathologist blinded to clinical and imaging results.
Fifty four patients with a mean age of 40.3 years and a male-to-female ratio of 5:1 were included. The mean cumulative methotrexate dose was 3.04 g. The median FIB4, APRI, and gamma-glutamyl transpeptidase-to-platelet ratio values were 0.75, 0.23, and 0.15, respectively. The median LSM for TE and SWE was 5.3 and 7.32 kPa, respectively. SWE and TE showed a weak positive correlation (r = 0.26, P = 0.053). The mean CAP was 217 dB/m (area under the receiver operating characteristic = 0.70). In the 19 of 26 cases whose liver biopsies could be assessed, only 4 (21%) showed F1 fibrosis (Ishak staging). The median LSM on SWE was significantly higher in patients with a cumulative methotrexate dose ≥ 4 g when compared with those with a dose <4 g (9.85 vs 7.1, P = 0.02). Other parameters did not correlate with TE and SWE.
The small sample size and the low number of cases with significant fibrosis on histopathology were the major limitations of this study.
Histologically detectable LF is uncommon in patients with psoriasis and reactive arthritis on long-term methotrexate therapy. Both TE and SWE are good at detecting the absence of fibrosis in these patients. In our study, SWE and TE values did not correlate with clinical, biochemical, or histopathological parameters.
长期低剂量甲氨蝶呤治疗与肝纤维化有关。虽然肝活检是检测纤维化的金标准，但它是一种具有发病率和死亡率风险的侵入性操作。因此，已经研究了瞬时弹性成像（TE）和剪切波弹性成像（SWE）等非侵入性成像技术来测量肝硬度。
评估 TE 和 SWE 在检测长期接受甲氨蝶呤治疗的银屑病和反应性关节炎患者纤维化中的效用。
对 54 名接受≥1.5 g 甲氨蝶呤治疗的银屑病和反应性关节炎患者进行了一项横断面前瞻性研究。计算了各种临床和生化[纤维化 4 指数（FIB4）、天冬氨酸转氨酶-血小板比值指数（APRI）]参数，并使用 TE 和 SWE 进行了肝硬度测量（LSM）。使用受控衰减参数（CAP）测量脂肪变性程度。当需要时进行肝活检，并由一位对临床和影像学结果不知情的病理学家进行解释。
共纳入 54 名平均年龄为 40.3 岁、男女比例为 5:1 的患者。平均累积甲氨蝶呤剂量为 3.04 g。中位 FIB4、APRI 和γ-谷氨酰转肽酶-血小板比值分别为 0.75、0.23 和 0.15。TE 和 SWE 的中位 LSM 分别为 5.3 和 7.32 kPa。SWE 和 TE 呈弱正相关（r=0.26，P=0.053）。平均 CAP 为 217 dB/m（受试者工作特征曲线下面积=0.70）。在 26 例可评估肝活检的病例中，仅 4 例（21%）表现为 F1 纤维化（Ishak 分期）。与累积甲氨蝶呤剂量<4 g 的患者相比，累积剂量≥4 g 的患者 SWE 的中位 LSM 显著更高（9.85 vs 7.1，P=0.02）。其他参数与 TE 和 SWE 不相关。
本研究的主要局限性是样本量小，组织学上有显著纤维化的病例数少。
长期接受甲氨蝶呤治疗的银屑病和反应性关节炎患者中，组织学上可检测到的 LF 并不常见。TE 和 SWE 都擅长检测这些患者是否存在纤维化。在我们的研究中，SWE 和 TE 值与临床、生化或组织病理学参数不相关。
Zotero 插件