原发性胆汁性肝硬化(PBC)是一种自身免疫性疾病,与其他自身免疫性疾病的主要区别在于PBC对皮质类固醇、硫唑嘌呤及青霉胶等传统的免疫抑制治疗效果不佳。近年来,一些小范围试验和少量短期对照研究提示几种新药如熊去氧胆酸、秋水仙碱、苯丁酸氮芥、环孢素和本文所提到的氨甲蝶呤(MTX)对治疗PBC有益。表面上看来,MTX似乎并不适用于PBC,较多报道认为长期应用会导致肝损。肝损特点为隐匿性脂肪变、门脉前区纤维化及肝硬化,但可无症状和血清生化试验的异常。当MTX累计量>2g时,或伴有酒精中毒、肥胖和糖尿病预期会有肝损害。MTX肝损常发生于酗酒者,提示MTX本身并不具肝毒性作用,而降低酒精性肝损或其他类型脂肪坏死的阈值。然而严重MTX损伤也见于滴酒不沾者,单 Primary biliary cirrhosis (PBC) is an autoimmune disease, the main difference from other autoimmune diseases is the poor efficacy of PBC on traditional immunosuppressive therapy such as corticosteroids, azathioprine and penicillin. In recent years, several small-scale trials and small short-term controlled studies have suggested several new drugs such as ursodeoxycholic acid, colchicine, chlorambucil, cyclosporine and the methotrexate (MTX) pair mentioned here PBC beneficial treatment. On the face of it, MTX does not seem to apply to PBC, more often reported that long-term use can lead to liver damage. Liver damage characterized by occult steatosis, portal fibrosis and cirrhosis, but asymptomatic and abnormal serum biochemical tests. When MTX cumulative amount> 2g, or accompanied by alcoholism, obesity and diabetes are expected to have liver damage. MTX liver damage often occurs in alcoholics, suggesting that MTX itself does not have hepatotoxic effects, and reduce alcohol-induced liver damage or other types of fat necrosis threshold. However, severe MTX damage is also found in drops of alcohol non-stick, single