Intravenous methylprednisolone (IVMP) pulse therapy is the first-line treatment for the active phase of moderate to severe Graves' orbitopathy (GO). However, acute and severe liver damage has been reported during and after IVMP therapy. In this retrospective study, we investigated risk factors for liver dysfunction during and after IVMP therapy based on 175 Japanese patients with moderate to severe GO and treated at our center between 2003 and 2011. The results showed that seven patients developed severe liver dysfunction with elevated serum alanine aminotransferase (ALT > 300 U/L). Mild (40–100 U/L) and moderate (100–300 U/L) increases of ALT occurred in 62 patients (35%) and 10 patients (6%), respectively. Liver dysfunction was more frequently observed in males, in patients receiving high-dose methylprednisolone, and patients aged over 50 years. Preexistent viral hepatitis was significantly associated with liver dysfunction (65% in patients positive for hepatitis B core antibody and patients positive for hepatitis C virus antibodies). Our study confirmed the association of liver dysfunction with IVMP during and after treatment. It suggests that, in patients with GO, evaluation of preexisting risk factors—including viral hepatitis—and careful weekly monitoring of liver function during IVMP therapy and monthly thereafter for 12 months are warranted.
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机译：静脉注射甲基强的松龙（IVMP）脉冲疗法是中度至重度Graves眼病（GO）活动期的一线治疗。然而，在IVMP治疗期间和之后，已经报道了急性和严重肝损伤。在这项回顾性研究中，我们根据2003年至2011年在我中心接受治疗的175例日本中度至重度GO患者，调查了IVMP治疗期间和之后肝功能障碍的危险因素。结果显示，有7例患者出现了血清水平升高的严重肝功能障碍丙氨酸氨基转移酶（ALT> 300 U / L）。 ALT轻度升高（40–100 U / L）和中度升高（100–300 U / L），分别有62例患者（35％）和10例患者（6％）。在男性，接受大剂量甲基强的松龙的患者以及年龄超过50岁的患者中，肝功能障碍的发生率更高。既往病毒性肝炎与肝功能异常显着相关（乙型肝炎核心抗体阳性的患者和丙型肝炎病毒抗体阳性的患者为65％）。我们的研究证实了治疗期间和治疗后肝功能不全与IVMP的关联。这表明，对于GO患者，应评估先前存在的危险因素（包括病毒性肝炎），并应在IVMP治疗期间每周仔细监测肝功能，此后每月进行12个月监测。
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