Do Muscle Enzyme Changes Forecast Liver Injury in Polymyositis/Dermatomyositis Patients Treated with Methylprednisolone and Methotrexate?

摘要

Background. Long-term use of hormones and immunosuppressive agents is necessary for treating polymyositis (PM)/dermatomyositis (DM) but may cause liver damage. At what point do the costs of treatment outweigh the benefits, and how will the breakeven point be determined? Methods. Serum muscle enzyme changes in 93 PM/DM patients were analyzed over the course of hormone and immunosuppressive agent treatment. From the analysis, a forecasting method was developed to help anticipate possible drug-induced liver injury. Results. Before treatment, CK levels were frequently elevated and showed correlation with ALT, AST, LDH and CK-MB levels (r=0.682, 0.766, 0.739 and 0.784, respectively). After treatment, all muscle enzyme levels were decreased except ALT (p>0.05). ALT level was positively correlated with CK level (r=0.681) in those patients whose CK level remained abnormal after treatment. Linear regression analysis yielded an equation(CK Level=12.66* ALT Level-136.23) that could predict potential liver damage. Conclusion. CK level was the most sensitive index of PM/DM and was highly correlated with other serum muscle enzyme levels. An equation capable of predicting potential liver damage according to the correlation of CK and ALT was produced.