风湿

甲氨蝶呤治疗RA肝酶升高的危险因素

作者:Hakamata J, et al 译者:重庆西南医院中西医结合风湿免疫中心 牟方祥 来源:中国风湿病公众论坛 日期:2018-02-17
导读

         甲氨蝶呤治疗类风湿关节炎患者肝酶升高异常的危险因素

关键字:  甲氨蝶呤 | RA | 肝酶 

        摘要:

        甲氨蝶呤(MTX)是治疗类风湿性关节炎的一线药物。在甲氨蝶呤的疗效和安全性存在很大的个体差异,而最常见的不良反应是肝毒性,但肝损伤的主要原因仍然不明。我们以医院为基础的队列研究,分析甲氨蝶呤导致肝酶升高的影响因素。

        方法:研究对象为服用甲氨蝶呤的114名日本成人RA门诊患者。采用实时荧光定量PCR法检测了15种单核苷酸多态性。从电子病历中收集患者信息。在使用MTX治疗过程中肝酶偏离正常参考值定义为MTX诱导的肝酶升高。观察期为MTX开始后1年。用多变量logistic回归模型评估MTX诱导肝酶升高与患者各个临床因素之间的联系。

        结果:32例患者出现MTX引起的肝酶异常升高。在多变量分析中,MTX的剂量、估算的肾小球滤过率、ABCB1 3435C>T和 ATIC 347C>G基因多态性与MTX诱导的肝酶异常升高有关。

        结论:在这个以医院为基础的队列研究中提示,日本RA患者MTX诱导的肝酶升高不但与MTX剂量和EGFR等非遗传因素有关,而且与ABCB1 3435C>T和 ATIC 347C>G遗传因素也相关。

        附原文:

        OBJECTIVES: Methotrexate (MTX) is used as first-linetreatment of rheumatoid arthritis (RA) worldwide. Large inter individualdifferences in MTX effectiveness and safety occur, and the most frequentadverse reaction is hepatotoxicity, although the main cause remains unknown. Weinvestigated factors associated with MTX-induced hepatic enzyme elevation in ahospital-based cohort study. METHODS:Study participants were 114 Japanese adult RA outpatients prescribed MTX.Fifteen types of single-nucleotide polymorphisms were investigated usingreal-time PCR. Patient characteristics were collected from the electronicmedical records. The onset of MTX-induced abnormal hepatic enzyme elevation wasdefined according to deviation from normal liver enzyme reference values duringtreatment. The observation period was 1 year after beginning MTX. Associationsbetween MTX-induced hepatic enzyme elevation and patient characteristics wereevaluated using the multivariate logistic regression model. RESULTS: Thirty-twopatients experienced MTX-induced abnormal hepatic enzyme elevation. Inmultivariate analysis, MTX dosage, estimated glomerular filtration rate (eGFR),and genetic polymorphisms of ABCB1 3435C>T and ATIC 347C>G were associated with abnormal hepatic enzymeelevation. CONCLUSIONS:MTX-induced abnormal hepatic enzyme elevation inJapanese RA patients was associated with dosage and eGFR as non-geneticfactors, and with ABCB1 3435C>T and ATIC 347C>G as genetic factors in this hospital-based cohortstudy.

        引自:Hakamata J,Hashiguchi M, Kaneko Y, et al. Risk factors for abnormal hepatic enzymeelevation by methotrexate treatment in patients with rheumatoid arthritis: ahospital based-cohort study[J]. Modern Rheumatology, 2017:1-27.

分享:

相关文章

评论

我要跟帖
发表
回复 小鸭梨
发表

copyright©金宝搏网站登录技巧 版权所有,未经许可不得复制、转载或镜像

京ICP证120392号  京公网安备110105007198  京ICP备10215607号-1  (京)网药械信息备字(2022)第00160号
//站内统计 //百度统计 //谷歌统计 //站长统计
*我要反馈: 姓    名: 邮    箱:
Baidu
map