Division of Dermatology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Division of Gastroenterology and Hepatology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Hong Kong Med J. 2024 Apr;30(2):110-119. doi: 10.12809/hkmj2210364.
Methotrexate (MTX) is effective for treating psoriasis and psoriatic arthritis, but its potential hepatoxicity remains a concern. Liver biopsy, the gold standard for detecting MTX-induced liver injury, is invasive and carries considerable risk. Transient elastography (TE) offers a non-invasive alternative for detecting advanced liver fibrosis. This study investigated the performance of TE in detecting MTX-induced liver fibrosis among Chinese psoriasis patients, compared with liver biopsy.
This study included adult patients with clinical psoriasis. Liver stiffness measurement using TE was performed in patients receiving MTX. Exclusion criteria were known liver cirrhosis, positive viral hepatitis carrier status, or conditions influencing TE performance. Liver biopsy was performed when liver stiffness was ≥7.1 kilopascals (kPa) or when the total cumulative dose (TCD) of MTX was ≥3.5 g.
A total of 228 patients were screened; among 34 patients who met the inclusion criteria, nine (26.5%) had significant liver fibrosis (Roenigk grade ≥3a). The area under the receiver operating characteristic curve was 0.76 (95% confidence interval=0.59-0.93; P=0.021), indicating that TE had satisfactory performance in detecting liver fibrosis. A cut-off value of 7.1 kPa of liver stiffness yielded 100% sensitivity and 68% specificity. Liver fibrosis was not correlated with the TCD of MTX or the duration of MTX use; it was significantly correlated with obesity and diabetes status (body mass index ≥30 kg/m, waist circumference ≥138 cm, and glycated haemoglobin level ≥7.8%).
Transient elastography is reliable and superior to the TCD for detecting liver fibrosis in Chinese psoriasis patients receiving MTX. Liver biopsy should be reserved for high-risk patients or patients with liver stiffness ≥11.7 kPa on TE.
甲氨蝶呤（MTX）对治疗银屑病和银屑病关节炎有效，但它潜在的肝毒性仍然令人担忧。肝活检是检测 MTX 诱导肝损伤的金标准，但具有侵袭性且风险较大。瞬时弹性成像（TE）为检测晚期肝纤维化提供了一种非侵入性替代方法。本研究旨在探讨 TE 在检测中国银屑病患者接受 MTX 治疗时发生的肝纤维化的表现，并与肝活检进行比较。
本研究纳入了接受 MTX 治疗的成年银屑病患者。对接受 MTX 治疗的患者进行 TE 肝硬度测量。排除标准包括已知的肝硬化、乙型或丙型肝炎病毒阳性携带状态、或影响 TE 检测结果的疾病。当肝硬度≥7.1 千帕（kPa）或 MTX 总累积剂量（TCD）≥3.5 g 时进行肝活检。
共筛选了 228 例患者，其中 34 例符合纳入标准，9 例（26.5%）存在明显的肝纤维化（Roenigk 分级≥3a）。受试者工作特征曲线下面积为 0.76（95%置信区间=0.59-0.93；P=0.021），表明 TE 检测肝纤维化的性能良好。肝硬度的截断值为 7.1 kPa 时，具有 100%的灵敏度和 68%的特异性。肝纤维化与 MTX 的 TCD 或 MTX 使用时间无关，与肥胖和糖尿病状态显著相关（体重指数≥30 kg/m、腰围≥138 cm、糖化血红蛋白水平≥7.8%）。
在接受 MTX 治疗的中国银屑病患者中，TE 是一种可靠且优于 TCD 的检测肝纤维化的方法。对于高危患者或 TE 肝硬度≥11.7 kPa 的患者，应保留肝活检。
