[Clinical characteristics of patients with rheumatic diseases and abnormal liver function].

Objective: To investigate the clinical characteristics of patients with rheumatic diseases and abnormal liver function, as well as determine the proportion and severity of liver function abnormalities. Methods: Cross-sectional study. Data were collected from patients registered in the Chinese Rheumatism Date Center from 2011 to 2021. The rheumatic diseases analyzed in this study were rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren syndrome (SS), ankylosing spondylitis (AS), and gout. Patient data, including demographic characteristics [ such as age, sex, body mass index,(BMI), and smoking history], liver function test results [including alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase(ALP), and total bilirubin], and use of anti-rheumatic immune drugs and liver-protective drugs, were collected and compared between groups with normal and abnormal liver functions. In addition, the proportions of abnormal liver function were compared between sex and age groups. Results: A total of 116 308 patients were included in this study, including 49 659 with RA, 17 597 with SLE, 9 039 with SS, 11 321 with AS, and 28 692 with gout. The lowest proportion of liver function abnormalities was observed in patients with RA[11.02% (5 470/49 659)], followed by those with SS[17.97% (1 624/9 039)] and AS [18.22% (2 063/11 321) ], whereas patients with SLE [21.14% (3 720/17 597) ] and gout [28.73% (8 242/28 692)] exhibited the highest proportion of these abnormalities. Elevated ALT, mostly classified as grade 1, was the most commonly noted liver function abnormality, whereas elevated ALP was the least common. Some patients who took liver-protective drugs had normal liver function, with the lowest percentage observed in patients with gout [7.45% (36/483) ] and ranging from 21.7% to 30.34% in patients with RA, SLE, SS, and AS. The proportion of liver function abnormalities was higher in males than in females for all disease types [RA: 13.8%(1 368/9 906) vs. 10.3%(4 102/39 753); SLE: 33.6% (479/1 424) vs. 20.0% (3 241/16 173); SS: 25.4%(111/437) vs. 17.6%(1 513/8 602); AS: 20.1%(1 629/8 119) vs. 13.6% (434/3 202); and gout: 29.3% (8 033/27 394) vs. 16.1% (209/1 298)]. In RA, SLE, and AS, the proportions of liver function abnormalities were similar across all age groups. In SS, the proportion of liver function abnormalities increased with age [<40 years: 14.9%(294/1 979); 40-59 years: 18.1%(858/4 741); ≥60 years: 20.4%(472/2 319)], whereas a reversal of this trend was observed in gout [<40 years: 34.9%(4 294/12 320); 40-59 years: 25.5%(2 905/11 398);≥60 years: 21.0%(1 042/4 971)]. Conclusions: The proportions of combined liver function abnormalities in patients with rheumatologic diseases were high, and the utilization rates of liver-protective drugs were low. It is necessary to pay more attention to monitoring patients' liver function, timely administer liver-protective drugs, and optimize liver-protective regimens during the treatment of rheumatic diseases.目的： 分析常见风湿免疫病患者合并肝功能异常的临床特征及严重程度。 方法： 横断面调查。患者来自2011至2021年在国家风湿病诊疗数据中心（CRDC）平台登记注册的类风湿关节炎（RA）、系统性红斑狼疮（SLE）、干燥综合征（SS）、强直性脊柱炎（AS）、痛风患者。收集患者的一般人口学资料（包括年龄、性别、体重指数、吸烟史等）、肝功能检查结果（包括丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、总胆红素等）、抗风湿免疫药物和保肝药物的使用情况。分析患者的临床特征、肝功能异常的比例、不同性别和年龄段的肝功能异常率。 结果： 共纳入116 308例患者，其中RA患者49 659例，SLE患者17 597例，SS患者9 039例，AS患者11 321例，痛风患者28 692例。RA患者肝功能异常比例最低［11.02%（5 470/49 659）］，其次是SS患者［17.97%（1 624/9 039）］和AS患者［18.22%（2 063/11 321）］，而SLE患者［21.14%（3 720/17 597）］和痛风患者［28.73%（8 242/28 692）］最高。肝功能异常以丙氨酸转氨酶升高为主，且大多数为1级，碱性磷酸酶升高的比例最低。服用保肝药物的患者中，肝功能正常比例痛风患者最低［7.45%（36/483）］，余为21.7%~30.34%。RA、SLE、SS、AS、痛风患者中，男性肝功能异常率均高于女性［RA：13.8%（1 368/9 906）比10.3%（4 102/39 753）；SLE：33.6%（479/1 424）比20.0%（3 241/16 173）；SS：25.4%（111/437）比17.6%（1 513/8 602）；AS：20.1%（1 629/8 119）比13.6%（434/3 202）；痛风：29.3%（8 033/27 394）比16.1%（209/1 298）］。RA、SLE、AS患者中，各年龄段的肝功能异常率相似；SS患者中，肝功能异常率随年龄增大而升高［<40岁者为14.9%（294/1 979）；40~59岁者为18.1%（858/4 741）；≥60岁者为20.4%（472/2 319）］；痛风患者肝功能异常率随年龄增大而降低［<40岁者为34.9%（4 294/12 320）；40~59岁者为25.5%（2 905/11 398）；≥60岁者为21.0%（1 042/4 971）］。 结论： 风湿免疫病患者合并肝功能异常的比例较高，但保肝药物的使用率低。风湿免疫病的诊疗过程中需提高对肝功能监测的重视，可考虑适时应用保肝药物，优化保肝治疗方案。.