Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India.
Department of Hepatology, PGIMER, Chandigarh, India.
Indian J Dermatol Venereol Leprol. 2020 Nov-Dec;86(6):649-655. doi: 10.4103/ijdvl.IJDVL_152_19.
Many international guidelines on psoriasis management have emphasized upon the need to identify risk factors for liver fibrosis and that the risk may be increased after a certain total cumulative dose of methotrexate.
Consecutive patients with moderate-to-severe psoriasis were assessed for liver fibrosis using transient elastography and noninvasive scores. Based on the presence of significant liver fibrosis, the Odds ratio associated with various factors was calculated using logistic regression analysis. Receiver operating characteristic curves were calculated to find maximal cutoff values of noninvasive tests to detect fibrosis.
In this cross-sectional study, 134 patients completed the study. Significant fibrosis (liver stiffness measurement ≥7, corresponding to F2 fibrosis or higher) was seen in 33 (24.6%) patients. Neither methotrexate exposure nor total cumulative dose of ≥1.5 was associated with significant fibrosis. Female sex (P = 0.024) and the presence of metabolic syndrome (P = 0.034) were the two variables associated with significant liver fibrosis. On logistic regression analysis, the odds ratio for the female gender and metabolic syndrome was estimated to be 2.51 (95% confidence interval - 1.09-5.81) and 2.33 (95% confidence interval - 1.03-5.27), respectively. Aspartate transaminase to platelet ratio index, nonalcoholic fatty liver disease score and the fibrosis-4 index had low sensitivity in comparison to transient elastography.
These included small sample size, small number of patients with a total cumulative methotrexate dose of >3-4.5 g, and lack of control group consisting of healthy persons. Another is the absence of liver biopsies considered as the gold standard in the diagnosis of liver fibrosis.
Metabolic syndrome and female sex are associated with the development of significant liver fibrosis in patients with psoriasis. Methotrexate exposure does not seem to be significantly associated with significant liver fibrosis.
许多国际银屑病管理指南都强调了识别肝纤维化风险因素的重要性，并且在使用甲氨蝶呤达到一定的总累积剂量后，风险可能会增加。
连续评估中重度银屑病患者的肝纤维化情况，使用瞬时弹性成像和非侵入性评分。根据是否存在显著肝纤维化，使用逻辑回归分析计算与各种因素相关的优势比。计算受试者工作特征曲线以找到检测纤维化的最大无创测试截断值。
在这项横断面研究中，共有 134 名患者完成了研究。33 名（24.6%）患者存在显著纤维化（肝脏硬度测量值≥7，对应 F2 纤维化或更高）。甲氨蝶呤暴露或累积剂量≥1.5 与显著纤维化无关。女性（P=0.024）和代谢综合征（P=0.034）是与显著肝纤维化相关的两个变量。在逻辑回归分析中，女性和代谢综合征的比值比估计分别为 2.51（95%置信区间 1.09-5.81）和 2.33（95%置信区间 1.03-5.27）。与瞬时弹性成像相比，天门冬氨酸氨基转移酶与血小板比值指数、非酒精性脂肪性肝病评分和纤维化-4 指数的敏感性较低。
这些局限性包括样本量小、累积甲氨蝶呤剂量>3-4.5 g 的患者数量少、缺乏由健康人组成的对照组，以及缺乏作为肝纤维化诊断金标准的肝活检。
代谢综合征和女性是银屑病患者发生显著肝纤维化的相关因素。甲氨蝶呤暴露似乎与显著肝纤维化无显著相关性。
