甲氨蝶呤治疗致类风湿关节炎患者肝功能损害的危险因素分析  

Analysis of risk factors for hepatic dysfunction by methotrexate treatment in patients with rheumatoid arthritis

作　　者：苏松森[1] 林燕芳[2] 洪磊 SU Songsen;LIN Yanfang;HONG Lei(Department of Rheumatology,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian,362000,China;Department of Pharmacy,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian,362000,China)

机构地区：[1]福建医科大学附属泉州第一医院风湿科,福建泉州362000 [2]福建医科大学附属泉州第一医院药剂科,福建泉州362000

出　　处：《当代医学》2022年第26期50-53,共4页Contemporary Medicine

摘　　要：目的分析甲氨蝶呤(MTX)治疗致类风湿性关节炎(RA)患者肝功能损害的危险因素。方法回顾性分析2019年1月至2020年1月于本院接受MTX治疗的208例RA患者的临床资料,根据是否发生肝酶异常升高分为肝功能损害组(n=51)和非肝功能损害组(n=157)。采用多因素Logistic回归模型分析MTX诱导的肝功能损害的危险因素。结果208例RA患者中,非肝功能损害157例(75.48%),丙氨酸转氨酶(ALT)无异常;肝功能损害51例(24.52%),ALT>40单位/L。两组体重指数(BMI)、MTX剂量、肾小球滤过率(GFR)水平、叶酸剂量、高脂血症、饮酒比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,高剂量MTX、未服用叶酸是MTX致肝功能损害的独立危险因素(OR>1,P<0.05);GFR高水平、饮酒呈阴性、未合并高脂血症是MTX致肝功能损害的保护因素(OR<1,P<0.05)。结论高MTX剂量、未服用叶酸可导致接受MTX治疗的RA患者肝功能损伤,临床治疗时需制订相关预防措施,以改善患者预后。Objective To analyse risk factors for hepatic dysfunction by methotrexate(MTX)treatment in patients with rheumatoid arthritis(RA).Methods The clinical data of 208 RA patients who received MTX treatment in our hospital from January 2019 to January 2020 were retrospectively analyzed,and they were divided into hepatic dysfunction group(n=51)and non-hepatic dysfunction group(n=157)according to whether abnormal hepatic enzyme elevation occured.Multivariate Logistic regression model was used to analyze the risk factors of hepatic dysfunction by MTX treatment.Results Among 208 RA patients,157 cases(75.48%)had non-hepatic dysfunction,and alanine aminotransferase(ALT)was normal;51 cases(24.52%)experienced hepatic dysfunction,and ALT>40 units/L.There were significant differences in body mass index(BMI),MTX dose,glomerular filtration rate(GFR)level,folic acid dose,hyperlipidemia and alcohol consumption between the two groups(P<0.05).Multivariate Logistic regression analysis showed that high-dose MTX,no folic acid intake were independent risk factors for hepatic dysfunction by MTX treatment(OR>1,P<0.05);high levels of GFR,negative for drinking,and no hyperlipidemia were protective factors for hepatic dysfunction by MTX treatment(OR<1,P<0.05).Conclusion High-dose MTX,no folic acid intake were independent risk factors for hepatic dysfunction by MTX treatment in patients with RA,and relevant preventive measures should be formulated in clinical treatment,to improve the prognosis of patient.

关 键 词：肝功能损害 甲氨蝶呤 类风湿关节炎 危险因素 

分 类 号：R593.22[医药卫生—内科学]