儿童幼年特发性关节炎中甲氨蝶呤肝毒性：单中心研究。

Methotrexate Hepatotoxicity in Children with Juvenile Idiopathic Arthritis: A Single-Center Study.

机构信息

Department of Pediatrics, Cairo University, Cairo, Egypt.

出版信息

Curr Rheumatol Rev. 2021;17(2):242-246. doi: 10.2174/1573397116666201211123142.

DOI:10.2174/1573397116666201211123142

PMID:33308133

Abstract

BACKGROUND

Juvenile idiopathic arthritis (JIA) could be disabling if left untreated. Methotrexate (MTX) is well known as a cornerstone in management. However, its adverse effects may limit treatment.

OBJECTIVE

The objective of this study was to evaluate the frequency of hepatotoxicity based on liver chemistry in JIA children receiving MTX.

METHODS

An observational case-control study of children with JIA who attend the Pediatric Rheumatology Unit, Cairo University Pediatric Hospital, Egypt, from January 2018 to December 2018 was carried out. Data were retrieved for 80 children; 50 (62.5%) were prescribed MTX. Their demographic, clinical characteristics, mean dose, duration of MTX therapy and other medications were described. Hepatotoxicity was defined as at least one value above the normal laboratory range of either ALT or AST during the study period.

RESULTS

Fourteen patients developed hepatotoxicity, giving an incidence of 28%. Children receiving MTX had higher alanine aminotransferase (ALT) interquartile range (IQR) (26 [21-359] vs. 23[20-32]; p =0.003), higher aspartate aminotransferase (AST) interquartile range (IQR) (31 [22-267] vs. 28[2-35] IU/L; p <0.001), and lower alkaline phosphatase (ALP) mean (±SD) (98±35.5 vs. 256 ± 39.5 IU/L; p <0.001). However, there were no significant differences in age, sex, weight, type of JIA, and duration of MTX treatment (p< 0.05).

CONCLUSION

Hepatotoxicity due to MTX, based on liver chemistry, is common among children with JIA.

摘要

背景

幼年特发性关节炎（JIA）如果不治疗可能会导致残疾。甲氨蝶呤（MTX）是治疗 JIA 的基石药物，但其不良反应可能会限制其治疗。

目的

本研究旨在评估接受甲氨蝶呤（MTX）治疗的 JIA 儿童基于肝化学的肝毒性的发生频率。

方法

对 2018 年 1 月至 2018 年 12 月在埃及开罗大学儿童医院儿科风湿病科就诊的 JIA 儿童进行了一项观察性病例对照研究。共纳入 80 例儿童，其中 50 例（62.5%）被开具 MTX。描述了他们的人口统计学、临床特征、平均剂量、MTX 治疗时间和其他药物的使用情况。肝毒性定义为在研究期间至少有一次 ALT 或 AST 值超过正常实验室范围。

结果

14 例患者发生肝毒性，发生率为 28%。接受 MTX 治疗的儿童丙氨酸氨基转移酶（ALT）的四分位间距（IQR）更高（26[21-359]vs.23[20-32]；p=0.003），天门冬氨酸氨基转移酶（AST）IQR 更高（31[22-267]vs.28[2-35]IU/L；p<0.001），碱性磷酸酶（ALP）平均值（±SD）更低（98±35.5vs.256±39.5IU/L；p<0.001）。然而，两组儿童在年龄、性别、体重、JIA 类型和 MTX 治疗持续时间方面均无显著差异（p>0.05）。