Background The liver damage in SLE usually occurs in 60% of cases. Histological investigation shows plethora, blood stagnation in the vessels, fat infiltration and necrosis in the portal system. The data on the liver pathology in SLE in children and adolescents are quite poor. Clinical and laboratory instrumental signs of the liver damage lack both in diagnostic criteria of SLE and in SLICC/ACR damage index. Together with that, liver is a hidden target organ, the pathological changes in which can be registered at the fibrosis formation stage.
Objectives To determine the liver function tests and determination of the stage of fibrosis in the adolescents with SLE at the onset of disease.
Methods The study involved 48 patients with SLE (mostly female (90,00%). The mean age of the patients was 14,4 years (172,9±4,72 months). The diagnosis was based on SLICC, 2012 criteria. The functional state of liver was examined with a complex of clinical laboratory, biochemical and instrumental methods (objective examination, ultrasound investigation of liver and gallbladder, the levels of bilirubin and its fractions, general cholesterol, the activities of alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (AP). De Ritis's coefficient (AST/ALT) and APRI index (Aspartate-aminotransferase-to-Platelet Radio Index) have been estimated.
Results At the onset of SLE an increase in size and an increase in transaminase activity were registered in 11 of 48 patients (22,9%). The SLE onset age in this group was 14,1 years (169,09±5,91 months), the mean SLE duration was 4,63±1,90 months, 54,5% of the patients had subacute onset and 63,6% had an increased activity of pathological process. 81,1% had liver cytolysis manifestations (increase in ALT (115,66±5,42 IU/l), AST (60,6±3,47 IU/l), decrease in De Ritis's coefficient (down to 0,79 with its normal values 1,3–1,4). 37,4% of the patients of this group had De Ritis's coefficient higher than 1,0 (AST prevailing) that is more typical for “cardiac” cytolysis. 63,6% of the patients of this group had De Ritis's coefficient lower than 1,0 (ALT prevailing) that is an evidence of liver changes. Activity of AP and pigment metabolism did not have changes. The level of cholesterol in the serum was decreased in 30,0%. USI data showed an increase in the size of liver in 81,81% of the patients, an increase in parenchyma echogenicity and fading of ultrasound signal in deep layers. AST positively correlated with CRP (r=0,67, p<0,05), sialic acids (r=0,66, p<0,05), glycoproteins (r=0,62, p<0,05); ALT positively correlated with the level of circulating immune complexes (r=0,81, p<0,001). Tests for fibrosis showed an increased risk of its formation in 27,3% of patients at the onset of SLE, and its reliable probability in 9,1% (APRI index 1,1).
Conclusions Liver is involved in SLE, with high occurrence of liver damage manifested as cytolisis, a decrease in synthetic activity, signs of fibrogenesis activation and the presence of the initial stage of fibrosis in some patients at adolescent age. The degree of changes depends on SLE activity and the presence of cardiac and renal syndromes. The examination of the patients should take into account the markers of functional state of liver, including inflammatory activity and fibrosis formation. A timely discovery of such changes can benefit the therapy able to decrease their progress.
Disclosure of Interest None declared