| Objectives1.To study the clinical features of liver involvement in systemic lupus erythematosus,the primary type of antoimmue diseases,to provide reliable clue for clinical diagnosis and differential diagnosis.2.To discuss the side effect of corticosteroids or immunosuppressants treatment on hepatitis reactivation in hepatitis B virus carrying autoimmune rheumatic patients,in order to provide rational treatment.MethodsPart 1 A retrospective review of cases of 566 SLE in-patients from June 2002 to November 2007 was performed.The following data were compared between lupus-associated hepatitis patients and patients without liver disorder:general conditions,lab findings and prognosis.The risk factors of lupus-associated hepatitis patients were analysed.The suspected risk factors were selected and then analyzed by chi-square test and Logistic regression.Part 2 A retrospective review of medical records of 1013 hospitalized patients with autoimmune diseases from June 2002 to November 2007 was performed.The following data of HBsig positive patients were compared between hepatitis reactivation group and no hepatitis reactivation group:general conditions,hepatitis reactivation, application of inmunosuppressants and outcomes.ResultsPart 1 There were 102 cases of lupus-associated hepatitis in 566 SLE patients(18.02%).lupus-associated hepatitis patients had higher IgG (18.65±8.64 g/1 vs.15.80±7.14 g/l,P＜0.01),higher ESR(22.85±9.30 mm/h vs.19.89±9.70 mm/h,P＜0.05),higher SLEDAI score(13.3±8.4 vs. 11.3±6.5,P＜0.05) and shorter course(3.0±4.6 yr vs.4.2±6.0 yr, P＜0.05).70 cases(68.6%) of lupus-associated hepatitis recovered after 0.5～1 mg/kg corticosteroids and glutathione treatment during hospitalization.The risk factors of lupus-associated hepatitis were cerebral involved and age≤18 yrs.Part 2 Among i013 cases of autoimmune diseases 631 cases had been tested for hepatitis virus.40 cases(40/631,6.3%) were HBsAg positive. Among 40 cases,26 cases had been treated with corticosteroids and/or immunosuppressants therapy.6 cases(6/26,23.1%) developed hepatitis reactivation after immunosuppressive therapy,except 1 case had hepatitis reactivation before therapy already.In group given high dose(0.8~1g) intravenous methylprednisolone pulse therapy(IVMP),2 cases developed hepatitis reactivation(2/2,100%).In non-IVMP group,4 cases developed hepatitis reactivation(4/24,16.7%).No patient of those who were given sulfasalazine,cyclosporine A,mycophenolate mofetil or hydroxychloroquine developed hepatitis reactivation in this study.Conclusions:Part 1 Liver involvement is not rare in SLE patients.If a SLE patient has high SLEDAI score,short course,high IgG and ESR with abnormal liver function,lupus-associated hepatitis should be considered.Most patients had a good prognosis after corticosteroids and glutathione treatment therapy.The risk factors of lupus-associated hepatitis were cerebral involvement and age≤18 yr.Part 2 Landmark of viral hepatitis detection should be a routine test before corticosteroids and/or immunosuppressants treatment in autoimmune diseases.If the patient has hepatitis B infection,especially HBsAg positive,he should be given a serum test of HBVDNA and ALT routinely. Meanwhile,the patient should be under close monitoring of HBVDNA and ALT level.Before IVMP,lamivudine 100 mg/d p.o is recommended.
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