Arias J M, Morton K A, Albro J E, Patch G G, Valdivia S, Greenberg H E, Christian P E, Datz F L
Department of Radiology, University of Utah, Salt Lake City.
J Nucl Med. 1993 Nov;34(11):1905-9.
Hepatotoxicity may complicate therapy with methotrexate in patients with rheumatoid arthritis. Prevention of cirrhosis may depend upon early identification of liver damage, usually accomplished by serial biopsy. To determine the adequacy of noninvasive methods for identifying hepatotoxicity, 22 sets of data were obtained in patients undergoing therapy with methotrexate for rheumatoid arthritis. Comparisons were made between liver biopsy, hepatocellular enzymes and two noninvasive radioisotopic methods that have been shown to be abnormal in hepatocellular disease: the rate constant of excretion of the 14C-aminopyrine and the time from injection to peak hepatic activity of 99mTc-diisopropylimidodiacetic acid. The hepatocellular enzymes and the time-to-peak-activity of diisopropylimidodiacetic acid were not useful predictors of methotrexate-induced hepatotoxicity. The aminopyrine breath test was abnormal in approximately half the patients with hepatotoxicity but showed poor specificity. Noninvasive methods remain inferior to biopsy for the detection of mild to moderate methotrexate-induced hepatotoxicity in patients with rheumatoid arthritis.
肝毒性可能会使类风湿关节炎患者使用甲氨蝶呤治疗变得复杂。预防肝硬化可能取决于早期发现肝损伤，这通常通过系列活检来完成。为了确定用于识别肝毒性的非侵入性方法是否足够，我们收集了22例接受甲氨蝶呤治疗类风湿关节炎患者的数据集。对肝活检、肝细胞酶以及两种已证实在肝细胞疾病中会出现异常的非侵入性放射性同位素方法进行了比较：14C-氨基比林的排泄速率常数以及99mTc-二异丙基亚氨基二乙酸从注射到肝脏活性峰值的时间。肝细胞酶和二异丙基亚氨基二乙酸的活性峰值时间并不是甲氨蝶呤诱导肝毒性的有效预测指标。大约一半肝毒性患者的氨基比林呼气试验结果异常，但特异性较差。对于检测类风湿关节炎患者中轻度至中度甲氨蝶呤诱导的肝毒性，非侵入性方法仍不如活检。
