Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Br J Dermatol. 2024 Jul 16;191(2):275-283. doi: 10.1093/bjd/ljae069.
BACKGROUND: There are established risk factors for liver fibrosis (LF), but data on the impact of methotrexate on LF in patients with psoriasis are lacking. OBJECTIVES: This cross-sectional study aimed to determine the prevalence of LF in patients with psoriasis and to evaluate the relationship between LF, cumulative methotrexate dose and other LF risk factors. METHODS: Adults with a history of moderate-to-severe chronic plaque psoriasis were recruited between June 2020 and March 2021. Patients underwent transient elastography to evaluate LF. Three values for liver stiffness measurement (LSM) were assessed, indicating mild or worse LF (≥ 7 kPa), moderate or worse LF (≥ 7.9 kPa) and advanced LF (≥ 9.5kPa). Cumulative methotrexate dose and other potential risk factors for LF were assessed. RESULTS: Overall, 240 patients were recruited and 204 participants with valid LSM values were included in the analysis [median age 48 years [interquartile range (IQR) 37-57]; 51% female sex; 56% body mass index (BMI) ≥ 30 (kg m-2) and a median Alcohol Use Disorders Identification Test (AUDIT) score of 4 (IQR 1-7, 23% score ≥ 8)]. In total, 91% had received methotrexate [median duration 36 months (IQR 14-78)]. Prevalence of LF was 36%, 25% and 17% using LSM ≥ 7 kPa, ≥ 7.9 kPa and ≥ 9.5 kPa, respectively. There was no association between cumulative methotrexate dose [median 2.16 (IQR 0.93-5.2)] and continuous LSM values [unstandardized coefficient 0.16, 95% confidence interval (CI) -0.49 to 0.82, P = 0.626] or using the categorical LSM cutoff values: ≥ 7 kPa [unadjusted odds ratio 1.06 (95% CI 0.97-1.15), P = 0.192], ≥ 7.9 kPa [unadjusted odds ratio 1.03 (95% CI 0.94-1.12), P = 0.577] and ≥ 9.5 kPa (unadjusted odds ratio 1.01, 95% CI 0.91-1.12; P = 0.843). The following risk factors were associated with higher LSM values: BMI (P ≤ 0.001), waist circumference (P ≤ 0.001), metabolic syndrome (P ≤ 0.001), AUDIT score (P = 0.020) and FIB-4 score (P = 0.03). BMI ≥ 28, diabetes and metabolic syndrome were shown to be better predictors of LF compared with FIB-4 score. CONCLUSIONS: This study confirms a high prevalence of significant LF in patients with psoriasis. Cumulative methotrexate dose was not associated with LF. Patients with BMI ≥ 28, metabolic syndrome and diabetes are at higher risk for LF. These risk factors may help to identify when a more detailed liver health assessment is needed.
背景：肝纤维化（LF）有明确的危险因素，但关于甲氨蝶呤对银屑病患者 LF 的影响的数据尚缺乏。
目的：本横断面研究旨在确定银屑病患者 LF 的患病率，并评估 LF、累积甲氨蝶呤剂量和其他 LF 危险因素之间的关系。
方法：2020 年 6 月至 2021 年 3 月期间招募了患有中重度慢性斑块型银屑病的成年人。患者接受瞬时弹性成像以评估 LF。评估了 3 个肝硬度测量（LSM）值，表明存在轻度或更严重的 LF（≥7kPa）、中度或更严重的 LF（≥7.9kPa）和严重的 LF（≥9.5kPa）。评估了累积甲氨蝶呤剂量和其他 LF 的潜在危险因素。
结果：共有 240 名患者入组，204 名有有效 LSM 值的参与者被纳入分析[中位年龄 48 岁[四分位距（IQR）37-57]；51%为女性；56%的 BMI≥30（kg m-2），中位数酒精使用障碍识别测试（AUDIT）得分为 4（IQR 1-7，23%的得分≥8）]。总共 91%的患者接受过甲氨蝶呤治疗[中位治疗持续时间 36 个月（IQR 14-78）]。使用 LSM≥7kPa、≥7.9kPa 和≥9.5kPa 时，LF 的患病率分别为 36%、25%和 17%。累积甲氨蝶呤剂量[中位数 2.16（IQR 0.93-5.2）]与连续 LSM 值之间无相关性[未标准化系数 0.16，95%置信区间（CI）-0.49 至 0.82，P=0.626]，或使用分类 LSM 截断值时也无相关性：≥7kPa[未调整的优势比 1.06（95%CI 0.97-1.15），P=0.192]、≥7.9kPa[未调整的优势比 1.03（95%CI 0.94-1.12），P=0.577]和≥9.5kPa（未调整的优势比 1.01，95%CI 0.91-1.12；P=0.843）。以下危险因素与较高的 LSM 值相关：BMI（P≤0.001）、腰围（P≤0.001）、代谢综合征（P≤0.001）、AUDIT 评分（P=0.020）和 FIB-4 评分（P=0.03）。BMI≥28、糖尿病和代谢综合征与 FIB-4 评分相比，是 LF 的更好预测因子。
结论：本研究证实了银屑病患者 LF 患病率较高。累积甲氨蝶呤剂量与 LF 无关。BMI≥28、代谢综合征和糖尿病的患者 LF 风险更高。这些危险因素可能有助于确定何时需要更详细的肝脏健康评估。
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