[Abstract]
Objective: Adult-onset Still’s disease (AOSD) is a systemic disorder commonly accompanied by liver involvement. This study aims to illustrate the detailed information of liver abnormalities in patients with AOSD and evaluate the impact on the prognosis.
Methods: A total number of 128 hospitalized patients, who met the Yamaguchi criteria of AOSD in the Department of Rheumatology and Immunology, Ruijin Hospital from July 2016 to August 2019 were consecutively enrolled and followed up. The demographic characteristics, clinical features, laboratory tests, treatments and prognosis were recorded. Correlations of liver function tests (LFTs) with disease activity and laboratory parameters were analyzed by the Spearman test. Risk factors of the refractory AOSD were evaluated by multivariate logistic regression analysis.
Results: Liver involvement was presented in 104 (81.3%) patients with AOSD. We observed that 34 (32.7%) patients were with mild elevation, 32 (30.8%) patients were with moderate elevation, and 38 (36.5%) patients were with severe elevation. The majority of elevated ALT, AST and ALP decreased to normal within the range of 2 months, except for GGT. Furthermore, the LFTs were found significantly correlated with disease activity. Besides, we found patients with higher levels of LFTs tended to require more intensive treatments and suffered from poorer prognosis. Multivariate logistic regression analysis showed ALP≥141 IU/L and GGT≥ 32 IU/L are independent risk factors of refractory AOSD.
Conclusion: Liver involvement is common in patients with AOSD, the levels of LFTs are associated with disease activity and related to the treatment strategies and prognosis.
【中文摘要】
目的：成人斯蒂爾病(AOSD)是一種系統性的自身炎症性疾病，常伴有肝臟受累。本研究旨在闡明AOSD患者肝臟受累的特徵，評估其對預後的影響。
方法：我們連續入組並隨訪了瑞金醫院風溼免疫科從2016年7月至2019年8月符合AOSD Yamaguchi診斷標準的128例住院患者。記錄了患者的人口學特徵、臨床特點、實驗室檢查、治療及預後。採用Spearman檢驗分析了肝功能檢查(LFT)與疾病活動性及實驗室指標的相關性。對難治性AOSD的危險因素進行多因素Logistic回歸分析。
結果：在128例AOSD患者中，104例(81.3%)患者存在肝臟受累，其中34例(32.7%)肝功能輕度升高，32例(30.8%)中度升高， 38例(36.5%)重度升高。除GGT外，大部分患者升高的ALT、AST和ALP在2個月內降至正常。LFTs與疾病活動性顯著相關。此外，LFTs水平較高的患者往往更需要強化治療，預後也更差。多因素Logistic回歸分析顯示，ALP≥141IU/L、GGT≥132IU/L是難治性AOSD的獨立危險因素。
結論：肝臟受累在AOSD患者中較常見，升高的LFTs水平與疾病活動性、治療策略及預後密切相關。