The Risk And/or Predictive Factors For Liver Function Damage In Patients With Non-digestive Autoimmune Diseases

Autoimmune diseases are a class of diseases caused by the body’s immune cells or immune effector molecules, which bring about pathological immune responses tothe body’s own tissue or cells, leading to damage. Patients with non-autoimmunedigestive diseases such as systemic lupus erythematosus, rheumatoid arthritis,ankylosing spondylitis are often associated with liver damage clinically. It is probablebecause of the key role which the liver plays in the process of immunomodulatoryin autoimmune diseases and simultaneously different degrees of liver damage occurs.However, the etiology and mechanism of the hepatic dysfunction in these diseases isnot yet entirely clear.The current studies suggest that the main reasons are:①Theautoantibodies and (or) sensitized lymphocytes acts on the tissues or cells where thetarget antigen is and cause damage.②Drugs induce liver injury.③Secondaryinfection, especially viral hepatitis occur to the liver because of theimmunosuppressive agents used in the treatment processes.There are a few studies probing the liver injury caused by the non-digestiveautoimmune diseases, they try to find out the risk factors and/or predictive factors ofhepatic dysfunction in patients with non-autoimmune digestive diseases. However,existing researches have the following problems: the conclusions differ greatly oreven reverse; the predictive factors included in each study are different, so it isdifficult to generalize them in a certain disease; The credibility of certain currentstudies is inadequate because of their small sample and the various research indicators;The exclusion criteria of some researches is not rigorous enough; Some studies justdetect the indicators of a certain disease, without analyzing the association betweenthe indicators and the disease; Currently, there have been many researches on therelated factors of lupus hepatitis abroad, but the incidence rate of this disease is stillcontroversial, because the exclusion criteria is not standard enough and it not easyto distinguish lupus hepatitis with autoimmune hepatitis; Analysis which is aboutrheumatoid arthritis or ankylosing spondylitis and the predictors about liver disorderis scant. There is not yet a unanimous predictor on liver damage in differentnon-digestive autoimmune diseases. Therefore, further study is necessary to explorethe individual risk factors and/or predictive factors on liver damage in differentnon-digestive autoimmune diseases and to explore whether there is consistent risk factors and/or predictive factors on liver damage among them.Objective: The aim of this study was to explore the risk factors and/or predictivefactors on liver damage in patients with systemic lupus erythematosus，rheumatoidarthritis，ankylosing spondylitis，Graves disease. Methods: We collected211cases ofsystemic lupus erythematosus,103cases of rheumatoid arthritis，92cases ofankylosing spondylitis，103cases of Graves disease patients in the first affiliatedhospital of Jinan university and the Nanfang Hospital from January2008to December2013, and analyzed the risk factors and/or predictive factors on liver damage in theforesaid diseases. Results:1. The prevalence of liver damage in patients with SLE,RA, AS, GD was19.4%，33%，31.5%and55.3%, respectively.2. Univariate analysisof SLE showed: the FT3, FT4levels of liver damage group were significantly lowerthan those without liver damage,and the disease duration was significantly shorterthan that without liver damage group, there was no significant difference in otherfactors; logistic regression analysis showed that duration of disease, FT3, FT4levelswere selected into the model.3. Univariate analysis in RA showed: the incidence ofprimary or even lower educational background and drug allergies in hepaticdysfunction group was significantly higher than the other group, and the level ofserum FT3, FT4significantly lower than the group without liver damage. There wasno significant difference in other factors; logistic regression analysis showed thateducational background,drug allergy history and the level of serum FT3, FT4wereselected into the model.4. Univariate analysis in AS showed：The HLA-B27-positiverate and the incidence of elevated levels of serum immunoglobulins IgG of the liverdisorder group was statistically higher than the other group，there was no significantdifference in other factors; logistic regression analysis showed that HLA-B27-positiveand elevated levels of serum immunoglobulins IgG were selected into the model.5.Univariate analysis in GD showed: the prevalence of drug allergy history in hepaticdysfunction group was significantly higher than the other group, Logistic regressionanalysis showed that drug allergy history was selected into the model. Conclusion1.Hepatic disorder is not rare in SLE, short course, low level of serum FT3and FT4may be predictive factors of liver dysfunction in SLE;2.Hepatic dysfunction is quite common in patients with RA, primary or even lower educational background,drugallergy, low level of serum FT3and FT4in RA patients may be the risk factors and/or predictive factors of liver damage;3.Hepatic dysfunction is quite common inpatients with ankylosing spondylitis, HLA-B27-positive, elevated serumimmunoglobulin in patients with AS may be the risk factors and/or predictive factorsof liver damage;4.Liver dysfunction is very common in patients with GD, drugallergies history may be a risk factor and/or predictive one of liver injury in patientswith Graves disease.