甲氨蝶呤和羟氯喹治疗的炎症性关节炎患者的肝纤维化：FIB-4 指数分析。

Liver fibrosis in inflammatory arthritis patients treated with methotrexate and hydroxychloroquine: A FIB-4 index analysis.

机构信息

Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.

出版信息

Int J Rheum Dis. 2024 Oct;27(10):e15390. doi: 10.1111/1756-185X.15390.

DOI:10.1111/1756-185X.15390

PMID:39439367

Abstract

OBJECTIVES

To evaluate the risk of liver fibrosis and associated factors with the non-invasive fibrosis score-4 (FIB-4) index in patients with inflammatory arthritis using methotrexate (MTX).

METHODS

Patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) who were followed up in the rheumatology outpatient clinic, who were on methotrexate only and for whom FIB-4 index was could be calculated at methotrexate initiation and follow-up were included. The FIB-4 index was calculated according to the following formula: age (years) × AST(IU/L)/(platelet count(10 (9)/L) × √ALT(IU/L)). The patients' demographics, comorbidities, other treatments, cumulative MTX dose, and reasons for MTX cessation were assessed. For the multivariate analysis, possible factors associated with intermediate-high risk FIB-4 index at last visit were determined.

RESULTS

A total of 107 patients were enrolled in the study, of whom 82 (76.6%) had RA and 25 (23.4%) had PsA. At the initiation of MTX, 24 (22.4%) patients had intermediate-high risk FIB-4 index. Comorbidities and the rate of ≥3-4 Charlson comorbidity index were more common in patients with intermediate-high risk FIB-4 index. A total of 37 (34.5%) patients had intermediate-high risk FIB-4 index at the last visit after median 3.6 (0.3-22.06) years follow-up. The median cumulative MTX dose was 2550 mg (1050-13.991). Cumulative MTX dose [OR 1.18 (1.01-1.33), p = .03] and diabetes mellitus [OR 4.60 (1.74-12.50), p = .002] were associated factors with intermediate-high risk FIB-4 index. The concomitant use of hydroxychloroquine (HCQ) was found to be a low-risk factor for FIB-4 index [OR 0.28 (0.10-0.78) p = .015].

CONCLUSION

The FIB-4 index is a non-invasive method that can be used in daily rheumatology practice for the evaluation and follow-up of patients who will use methotrexate. Comorbidities and cumulative MTX dose seem to be related with the risk of liver fibrosis. Concomitant use of HCQ with MTX may reduce the risk of liver fibrosis.

摘要

目的

评估使用甲氨蝶呤（MTX）治疗炎症性关节炎患者的非侵入性纤维化评分-4（FIB-4）指数的肝纤维化风险及其相关因素。

方法

本研究纳入了在风湿科门诊接受随访、仅接受 MTX 治疗且在 MTX 起始和随访时可以计算 FIB-4 指数的类风湿关节炎（RA）和银屑病关节炎（PsA）患者。FIB-4 指数的计算公式为：年龄（岁）×AST（IU/L）/（血小板计数（10^9/L）×√ALT（IU/L））。评估患者的人口统计学、合并症、其他治疗、累积 MTX 剂量和 MTX 停药原因。对多变量分析确定与最后一次就诊时中高危 FIB-4 指数相关的可能因素。

结果

本研究共纳入 107 例患者，其中 82 例（76.6%）为 RA 患者，25 例（23.4%）为 PsA 患者。在 MTX 起始时，24 例（22.4%）患者的 FIB-4 指数为中高危。中高危 FIB-4 指数患者的合并症和≥3-4 个 Charlson 合并症指数的发生率更高。在中位随访 3.6（0.3-22.06）年后，37 例（34.5%）患者的 FIB-4 指数为中高危。累积 MTX 剂量中位数为 2550mg（1050-13991）。累积 MTX 剂量[比值比（OR）1.18（1.01-1.33），p=0.03]和糖尿病[OR 4.60（1.74-12.50），p=0.002]是中高危 FIB-4 指数的相关因素。同时使用羟氯喹（HCQ）被认为是 FIB-4 指数的低风险因素[OR 0.28（0.10-0.78），p=0.015]。