C S M Wong, L L Y Mak, V K H Lee, R C L Lo, M M H Chung, F Chu, C K Yeung, M F Yuen, H H L Chan
{"title":"检测接受甲氨蝶呤治疗的中国银屑病患者的明显肝纤维化:瞬时弹性成像与肝组织学的比较。","authors":"C S M Wong, L L Y Mak, V K H Lee, R C L Lo, M M H Chung, F Chu, C K Yeung, M F Yuen, H H L Chan","doi":"10.12809/hkmj2210364","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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<sup>2</sup>, waist circumference ≥138 cm, and glycated haemoglobin level ≥7.8%).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":"30 2","pages":"110-119"},"PeriodicalIF":3.1000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Detection of significant liver fibrosis in Chinese psoriasis patients receiving methotrexate: a comparison between transient elastography and liver histology.\",\"authors\":\"C S M Wong, L L Y Mak, V K H Lee, R C L Lo, M M H Chung, F Chu, C K Yeung, M F Yuen, H H L Chan\",\"doi\":\"10.12809/hkmj2210364\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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<sup>2</sup>, waist circumference ≥138 cm, and glycated haemoglobin level ≥7.8%).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":48828,\"journal\":{\"name\":\"Hong Kong Medical Journal\",\"volume\":\"30 2\",\"pages\":\"110-119\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2024-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hong Kong Medical Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.12809/hkmj2210364\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hong Kong Medical Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.12809/hkmj2210364","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
简介:甲氨蝶呤(MTX)可有效治疗银屑病和银屑病关节炎,但其潜在的肝毒性仍令人担忧。肝脏活组织检查是检测 MTX 引起的肝损伤的金标准,但该检查具有侵入性且有相当大的风险。瞬态弹性成像(TE)为检测晚期肝纤维化提供了一种无创替代方法。与肝活检相比,本研究探讨了瞬态弹性成像在检测中国银屑病患者MTX诱导的肝纤维化方面的性能:本研究纳入了临床银屑病成年患者。方法:本研究纳入了临床银屑病成年患者,使用 TE 对接受 MTX 治疗的患者进行肝脏硬度测量。排除标准为已知的肝硬化、病毒性肝炎阳性携带者或影响 TE 性能的情况。当肝脏硬度≥7.1千帕斯卡(kPa)或MTX总累积剂量(TCD)≥3.5克时,进行肝活检:共筛选出 228 例患者,在 34 例符合纳入标准的患者中,9 例(26.5%)有明显的肝纤维化(Roenigk 分级≥3a)。接收者操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 在检测肝纤维化方面的性能令人满意。肝脏硬度的临界值为 7.1 kPa,敏感性为 100%,特异性为 68%。肝纤维化与MTX的TCD或MTX的使用时间无关;与肥胖和糖尿病状态(体重指数≥30 kg/m2,腰围≥138 cm,糖化血红蛋白水平≥7.8%)显著相关:瞬态弹性成像在检测接受MTX治疗的中国银屑病患者的肝纤维化方面可靠且优于TCD。肝脏活检应保留给高危患者或TE检测肝脏硬度≥11.7 kPa的患者。
Detection of significant liver fibrosis in Chinese psoriasis patients receiving methotrexate: a comparison between transient elastography and liver histology.
Introduction: 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.
Methods: 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.
Results: 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/m2, waist circumference ≥138 cm, and glycated haemoglobin level ≥7.8%).
Conclusion: 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.
期刊介绍:
The HKMJ is a Hong Kong-based, peer-reviewed, general medical journal which is circulated to 6000 readers, including all members of the HKMA and Fellows of the HKAM. The HKMJ publishes original research papers, review articles, medical practice papers, case reports, editorials, commentaries, book reviews, and letters to the Editor. Topics of interest include all subjects that relate to clinical practice and research in all branches of medicine. The HKMJ welcomes manuscripts from authors, but usually solicits reviews. Proposals for review papers can be sent to the Managing Editor directly. Please refer to the contact information of the Editorial Office.