肝脏是风湿免疫病最常受累的器官之一。风湿免疫病患者的肝脏病变可由疾病直接累及肝脏、合并其他原发性肝病或药物相关肝损伤等多种因素导致。当患者出现肝功能异常时，应仔细鉴别病因。对于病因不明的肝损伤，应常规检测自身抗体，以早期识别潜在的自身免疫性肝病。若病因仍不明确，建议在条件允许的情况下进行肝穿刺活检以确诊。在积极治疗风湿免疫病的同时，应密切监测肝功能变化，避免使用可能加重肝损伤的药物，尤其是肝毒性较强的抗风湿药物，并根据患者的具体情况调整治疗方案，降低肝损伤风险，优化长期预后。

The liver is one of the organs most commonly affected by rheumatic diseases. Hepatic abnormalities in patients with rheumatic diseases can result from a variety of factors，including direct liver involvement by the disease itself，coexistence with primary liver disease，and drug-induced liver injury. When liver indicators are abnormal，a thorough differential diagnosis is required. For unexplained liver dysfunction，routine testing for autoantibodies should be performed to facilitate early identification of underlying autoimmune liver disease. If the etiology remains unclear，a liver biopsy is recommended for a final diagnosis if feasible. Alongside active management of rheumatic diseases，it is necessary to closely monitor liver function，avoid the use of agents that may exacerbate hepatic damage，particularly anti-rheumatic drugs with strong hepatotoxicity，and tailor treatment strategies according to personal specific conditions，so as to minimize liver damage and improve long-term outcome.