Wu C Y, Li M C, Duan X W, Li H B, Wang Y H, Li Q, Luo H, Xu J, Wu L J, Wang Y F, Zhao C, Fang Y F, Lin S D, Xu D, Tian X P, Li M T, Zeng X F
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital,Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China.
Department of Rheumatology and Immunology, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China.
Zhonghua Nei Ke Za Zhi. 2023 Sep 1;62(9):1102-1113. doi: 10.3760/cma.j.cn112138-20220909-00669.
To investigate the clinical characteristics of patients with rheumatic diseases and abnormal liver function, as well as determine the proportion and severity of liver function abnormalities. Cross-sectional study. Data were collected from patients registered in the Chinese Rheumatism Date Center from 2011 to 2021. The rheumatic diseases analyzed in this study were rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren syndrome (SS), ankylosing spondylitis (AS), and gout. Patient data, including demographic characteristics [ such as age, sex, body mass index,(BMI), and smoking history], liver function test results [including alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase(ALP), and total bilirubin], and use of anti-rheumatic immune drugs and liver-protective drugs, were collected and compared between groups with normal and abnormal liver functions. In addition, the proportions of abnormal liver function were compared between sex and age groups. A total of 116 308 patients were included in this study, including 49 659 with RA, 17 597 with SLE, 9 039 with SS, 11 321 with AS, and 28 692 with gout. The lowest proportion of liver function abnormalities was observed in patients with RA[11.02% (5 470/49 659)], followed by those with SS[17.97% (1 624/9 039)] and AS [18.22% (2 063/11 321) ], whereas patients with SLE [21.14% (3 720/17 597) ] and gout [28.73% (8 242/28 692)] exhibited the highest proportion of these abnormalities. Elevated ALT, mostly classified as grade 1, was the most commonly noted liver function abnormality, whereas elevated ALP was the least common. Some patients who took liver-protective drugs had normal liver function, with the lowest percentage observed in patients with gout [7.45% (36/483) ] and ranging from 21.7% to 30.34% in patients with RA, SLE, SS, and AS. The proportion of liver function abnormalities was higher in males than in females for all disease types [RA: 13.8%(1 368/9 906) vs. 10.3%(4 102/39 753); SLE: 33.6% (479/1 424) vs. 20.0% (3 241/16 173); SS: 25.4%(111/437) vs. 17.6%(1 513/8 602); AS: 20.1%(1 629/8 119) vs. 13.6% (434/3 202); and gout: 29.3% (8 033/27 394) vs. 16.1% (209/1 298)]. In RA, SLE, and AS, the proportions of liver function abnormalities were similar across all age groups. In SS, the proportion of liver function abnormalities increased with age [<40 years: 14.9%(294/1 979); 40-59 years: 18.1%(858/4 741); ≥60 years: 20.4%(472/2 319)], whereas a reversal of this trend was observed in gout [<40 years: 34.9%(4 294/12 320); 40-59 years: 25.5%(2 905/11 398);≥60 years: 21.0%(1 042/4 971)]. The proportions of combined liver function abnormalities in patients with rheumatologic diseases were high, and the utilization rates of liver-protective drugs were low. It is necessary to pay more attention to monitoring patients' liver function, timely administer liver-protective drugs, and optimize liver-protective regimens during the treatment of rheumatic diseases.
调查风湿性疾病患者合并肝功能异常的临床特征，以及确定肝功能异常的比例和严重程度。横断面研究。收集2011年至2021年在中国风湿病数据中心登记的患者数据。本研究分析的风湿性疾病包括类风湿关节炎（RA）、系统性红斑狼疮（SLE）、干燥综合征（SS）、强直性脊柱炎（AS）和痛风。收集患者数据，包括人口统计学特征[如年龄、性别、体重指数（BMI）和吸烟史]、肝功能检查结果[包括丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶、碱性磷酸酶（ALP）和总胆红素]，以及抗风湿免疫药物和保肝药物的使用情况，并在肝功能正常和异常的组间进行比较。此外，还比较了性别和年龄组之间肝功能异常的比例。本研究共纳入116308例患者，其中RA患者49659例，SLE患者17597例，SS患者9039例，AS患者11321例，痛风患者28692例。RA患者肝功能异常比例最低[11.02%（5470/49659）]，其次是SS患者[17.97%（1624/9039）]和AS患者[18.22%（2063/11321）]，而SLE患者[21.14%（3720/17597）]和痛风患者[28.73%（8242/28692）]肝功能异常比例最高。ALT升高大多为1级，是最常见的肝功能异常，而ALP升高最不常见。一些服用保肝药物的患者肝功能正常，痛风患者中观察到的比例最低[7.45%（36/483）]，RA、SLE、SS和AS患者的比例在21.7%至30.34%之间。所有疾病类型中，男性肝功能异常比例均高于女性[RA：13.8%（1368/9906）对10.3%（4102/39753）；SLE：33.6%（479/1424）对20.0%（3241/16173）；SS：25.4%（111/437）对17.6%（1513/8602）；AS：20.1%（1629/8119）对13.6%（434/3202）；痛风：29.3%（8033/27394）对16.1%（209/1298）]。在RA、SLE和AS中，各年龄组肝功能异常比例相似。在SS中，肝功能异常比例随年龄增加而升高[<40岁：14.9%（294/1979）；40 - 59岁：18.1%（858/4741）；≥60岁：20.4%（472/2319）]，而在痛风中观察到这种趋势的逆转[<40岁：34.9%（4294/12320）；40 - 59岁：25.5%（2905/11398）；≥60岁：21.0%（1042/4971）]。风湿性疾病患者合并肝功能异常的比例较高，保肝药物的使用率较低。在风湿性疾病治疗过程中，有必要更加关注监测患者的肝功能，及时给予保肝药物，并优化保肝方案。
