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重视风湿免疫病的肝脏表现
DOI: 10.12449/JCH250501
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：王程瑶负责文献检索，撰写论文，整理内容；刘燕鹰负责整体构思与写作指导，参与文章内容审阅与修订，完成最终定稿。
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摘要: 肝脏是风湿免疫病最常受累的器官之一。风湿免疫病患者的肝脏病变可由疾病直接累及肝脏、合并其他原发性肝病或药物相关肝损伤等多种因素导致。当患者出现肝功能异常时，应仔细鉴别病因。对于病因不明的肝损伤，应常规检测自身抗体，以早期识别潜在的自身免疫性肝病。若病因仍不明确，建议在条件允许的情况下进行肝穿刺活检以确诊。在积极治疗风湿免疫病的同时，应密切监测肝功能变化，避免使用可能加重肝损伤的药物，尤其是肝毒性较强的抗风湿药物，并根据患者的具体情况调整治疗方案，降低肝损伤风险，优化长期预后。Abstract: The liver is one of the organs most commonly affected by rheumatic diseases. Hepatic abnormalities in patients with rheumatic diseases can result from a variety of factors， including direct liver involvement by the disease itself， coexistence with primary liver disease， and drug-induced liver injury. When liver indicators are abnormal， a thorough differential diagnosis is required. For unexplained liver dysfunction， routine testing for autoantibodies should be performed to facilitate early identification of underlying autoimmune liver disease. If the etiology remains unclear， a liver biopsy is recommended for a final diagnosis if feasible. Alongside active management of rheumatic diseases， it is necessary to closely monitor liver function， avoid the use of agents that may exacerbate hepatic damage， particularly anti-rheumatic drugs with strong hepatotoxicity， and tailor treatment strategies according to personal specific conditions， so as to minimize liver damage and improve long-term outcome.
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Key words:
- Rheumatic Diseases /
- Hepatic Insufficiency /
- Autoimmune Liver Diseases
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[1] SZEKANECZ Z, MCINNES IB, SCHETT G, et al. Autoinflammation and autoimmunity across rheumatic and musculoskeletal diseases[J]. Nat Rev Rheumatol, 2021, 17( 10): 585- 595. DOI: 10.1038/s41584-021-00652-9. [2] GEBRESELASSIE A, ADULI F, HOWELL CD. Rheumatologic diseases and the liver[J]. Clin Liver Dis, 2019, 23( 2): 247- 261. DOI: 10.1016/j.cld.2018.12.007. [3] PODGÓRSKA J, WEREL P, KLAPACZYŃSKI J, et al. Liver involvement in rheumatic diseases[J]. Reumatologia, 2020, 58( 5): 289- 296. DOI: 10.5114/reum.2020.99782. [4] WANG CR, TSAI HW. Autoimmune liver diseases in systemic rheumatic diseases[J]. World J Gastroenterol, 2022, 28( 23): 2527- 2545. DOI: 10.3748/wjg.v28.i23.2527. [5] Chinese Rheumatology Association, Chinese Medical Association; Rheumatology and Immunology Physician Branch, Chinese Medical Doctor Association; Branch Rheumatology, China Association of Chinese Medicine, et al. Chinese expert consensus on diagnosis and treatment of antirheumatic drug-induced liver injury(2024)[J]. Chin J Intern Med, 2024, 63( 8): 743- 761. DOI: 10.3760/cma.j.cn112138-20240418-00248.中华医学会风湿病学分会, 中国医师协会风湿免疫科医师分会, 中华中医药学会风湿病分会, 等. 抗风湿病药物性肝损伤诊治中国专家共识(2024年版)[J]. 中华内科杂志, 2024, 63( 8): 743- 761. DOI: 10.3760/cma.j.cn112138-20240418-00248. [6] ANDRADE RJ, AITHAL GP, BJÖRNSSON ES, et al. EASL Clinical Practice Guidelines: Drug-induced liver injury[J]. J Hepatol, 2019, 70( 6): 1222- 1261. DOI: 10.1016/j.jhep.2019.02.014. [7] YOUNOSSI Z, HENRY L. Contribution of alcoholic and nonalcoholic fatty liver disease to the burden of liver-related morbidity and mortality[J]. Gastroenterology, 2016, 150( 8): 1778- 1785. DOI: 10.1053/j.gastro.2016.03.005. [8] CHOWDHARY VR, CROWSON CS, POTERUCHA JJ, et al. Liver involvement in systemic lupus erythematosus: Case review of 40 patients[J]. 2008, 35( 11): 2159- 2164. DOI: 10.3899/jrheum.080336. [9] GONZÁLEZ-REGUEIRO JA, CRUZ-CONTRERAS M, MERAYO-CHALICO J, et al. Hepatic manifestations in systemic lupus erythematosus[J]. Lupus, 2020, 29( 8): 813- 824. DOI: 10.1177/0961203320923398. [10] PIGA M, VACCA A, PORRU G, et al. Liver involvement in systemic lupus erythematosus: Incidence, clinical course and outcome of lupus hepatitis[J]. Clin Exp Rheumatol, 2010, 28( 4): 504- 510. [11] SOLELA G, DABA M. Budd-Chiari syndrome as an initial presentation of systemic lupus erythematosus associated with antiphospholipid syndrome: A case report with review of the literature[J]. Open Access Rheumatol, 2023, 15: 139- 143. DOI: 10.2147/OARRR.S425535. [12] SUN Y, ZHANG WC, LI BS, et al. The coexistence of Sjögren’s syndrome and primary biliary cirrhosis: A comprehensive review[J]. Clin Rev Allergy Immunol, 2015, 48( 2-3): 301- 315. DOI: 10.1007/s12016-015-8471-1. [13] XIAO QF, FEI YY. The relationship between primary biliary cholangitis and Sjögren’s syndrome[J]. J Clin Hepatol, 2021, 37( 10): 2262- 2268. DOI: 10.3969/j.issn.1001-5256.2021.10.002.肖秋凤, 费允云. 原发性胆汁性胆管炎与干燥综合征的关系[J]. 临床肝胆病杂志, 2021, 37( 10): 2262- 2268. DOI: 10.3969/j.issn.1001-5256.2021.10.002. [14] FORBES A, MARIE I. Gastrointestinal complications: The most frequent internal complications of systemic sclerosis[J]. Rheumatology(Oxford), 2009, 48( Suppl 3): iii36-iii 39. DOI: 10.1093/rheumatology/ken485. [15] LIBERAL R, GRANT CR, SAKKAS L, et al. Diagnostic and clinical significance of anti-centromere antibodies in primary biliary cirrhosis[J]. Clin Res Hepatol Gastroenterol, 2013, 37( 6): 572- 585. DOI: 10.1016/j.clinre.2013.04.005. [16] NAGASHIMA T, KAMATA Y, IWAMOTO M, et al. Liver dysfunction in anti-melanoma differentiation-associated gene 5 antibody-positive patients with dermatomyositis[J]. Rheumatol Int, 2019, 39( 5): 901- 909. DOI: 10.1007/s00296-019-04255-2. [17] KUROKAWA M, HIOKI T, AOYAGI T, et al. Clinicopathologic features of adult-onset Still’s disease complicated by severe liver injury[J]. Intern Med, 2024, 63( 4): 503- 511. DOI: 10.2169/internalmedicine.2043-23. [18] CHI HH, WANG ZH, MENG JF, et al. A cohort study of liver involvement in patients with adult-onset Still’s disease: Prevalence, characteristics and impact on prognosis[J]. Front Med(Lausanne), 2020, 7: 621005. DOI: 10.3389/fmed.2020.621005. [19] CHEN SY, ZHAO XY. Clinicopathological characteristics and key therapeutic options for liver involvement with vasculitis[J]. Chin J Hepatol, 2023, 31( 9): 905- 909. DOI: 10.3760/cma.j.cn501113-20230813-00053.陈苏云, 赵新颜. 血管炎肝脏受累的临床病理特点及治疗要点[J]. 中华肝脏病杂志, 2023, 31( 9): 905- 909. DOI: 10.3760/cma.j.cn501113-20230813-00053. [20] WANG TQ, LIU YY. Advances in diagnosis and treatment of IgG4-related hepatobiliary and pancreatic diseases[J]. J Clin Hepatol, 2022, 38( 4): 762- 766. DOI: 10.3969/j.issn.1001-5256.2022.04.006.王天琪, 刘燕鹰. IgG4相关肝胆胰疾病诊疗进展[J]. 临床肝胆病杂志, 2022, 38( 4): 762- 766. DOI: 10.3969/j.issn.1001-5256.2022.04.006. [21] FIGUS FA, PIGA M, AZZOLIN I, et al. Rheumatoid arthritis: Extra-articular manifestations and comorbidities[J]. Autoimmun Rev, 2021, 20( 4): 102776. DOI: 10.1016/j.autrev.2021.102776. [22] RADOVANOVIĆ-DINIĆ B, TEŠIĆ-RAJKOVIĆ S, ZIVKOVIC V, et al. Clinical connection between rheumatoid arthritis and liver damage[J]. Rheumatol Int, 2018, 38( 5): 715- 724. DOI: 10.1007/s00296-018-4021-5. [23] MIHAI IR, REZUS C, BURLUI MA, et al. Autoimmune liver diseases and rheumatoid arthritis-Is there an etiopathogenic link?[J]. Int J Mol Sci, 2024, 25( 7): 3848. DOI: 10.3390/ijms25073848. [24] ZAMANI M, ALIZADEH-TABARI S, CHITKARA P, et al. Prevalence of nonalcoholic fatty liver disease in patients with rheumatoid arthritis: A systematic review and meta-analysis[J]. Clin Gastroenterol Hepatol, 2023, 21( 11): 2789- 2796. DOI: 10.1016/j.cgh.2023.02.021. [25] THORNE C, UROWITZ MB, WANLESS I, et al. Liver disease in Felty’s syndrome[J]. Am J Med, 1982, 73( 1): 35- 40. DOI: 10.1016/0002-9343(82)90921-4. [26] TOLEDO-IBELLES P, GUTIÉRREZ-VIDAL R, CALIXTO-TLACOMULCO S, et al. Hepatic accumulation of hypoxanthine: A link between hyperuricemia and nonalcoholic fatty liver disease[J]. Arch Med Res, 2021, 52( 7): 692- 702. DOI: 10.1016/j.arcmed.2021.04.005. [27] ORTOLAN A, LORENZIN M, TADIOTTO G, et al. Metabolic syndrome, non-alcoholic fatty liver disease and liver stiffness in psoriatic arthritis and psoriasis patients[J]. Clin Rheumatol, 2019, 38( 10): 2843- 2850. DOI: 10.1007/s10067-019-04646-7. [28] LIM LY, OON HH. Gastrointestinal and hepatic manifestations in patients with generalised pustular psoriasis[J]. Exp Dermatol, 2023, 32( 8): 1246- 1252. DOI: 10.1111/exd.14766. [29] ROBINSON AC, TEELING M, CASEY EB. Hepatic function in ankylosing spondylitis[J]. Ann Rheum Dis, 1983, 42( 5): 550- 552. DOI: 10.1136/ard.42.5.550. [30] KUNG YY, TSAI CY, TSAI YY, et al. Enthesopathy in a case of primary biliary cirrhosis with positive HLA-B27[J]. Clin Exp Rheumatol, 1997, 15( 6): 708- 709. [31] WU CY, LI MC, DUAN XW, et al. Clinical characteristics of patients with rheumatic diseases and abnormal liver function[J]. Chin J Intern Med, 2023, 62( 9): 1102- 1113. DOI: 10.3760/cma.j.cn112138-20220909-00669.吴婵媛, 李慕聪, 段新旺, 等. 风湿免疫病合并肝功能异常患者的临床特征[J]. 中华内科杂志, 2023, 62( 9): 1102- 1113. DOI: 10.3760/cma.j.cn112138-20220909-00669. [32] ZHU YL, YU HH. Diagnosis and treatment of autoimmune hepatitis-primary biliary cholangitis overlap syndrome[J]. Adv Clin Med, 2023, 13( 3): 4678- 4685. DOI: 10.12677/ACM.2023.133671.朱玉兰, 俞慧宏. 自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征的诊疗[J]. 临床医学进展, 2023, 13( 3): 4678- 4685. DOI: 10.12677/ACM.2023.133671. [33] MANNS MP, LOHSE AW, VERGANI D. Autoimmune hepatitis-update 2015[J]. J Hepatol, 2015, 62( 1): S100- S111. DOI: 10.1016/j.jhep.2015.03.005. -
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