^13C-美沙西丁呼气试验对评价肝癌肝储备功能的价值  

The value of studying liver function reserve in hepatic carcinoma by ^13C-methacetin breath test

作　　者：李红霞[1] 王俊平[1] 杨颖 张瑾[1] 冯秋玲[1] 

机构地区：[1]山西省人民医院消化内科,太原030012 [2]山西省职工医学院内科教研室

出　　处：《中华内科杂志》2009年第5期383-387,共5页Chinese Journal of Internal Medicine

摘　　要：目的观察肝癌患者^13C-美沙西丁呼气试验（^13C-MBT）检测的特点，并与临床Child—Pugh分级及常规肝功能检测项目进行对比，探讨^13C-MBT对评价肝癌肝储备功能的价值。方法选择山西省人民医院2005年7月2日至2006年6月15日就诊的原发性肝癌患者39例（根据Child-Pugh分级又分为A、B、C3个亚组）、转移性肝癌患者16例、健康对照者14例进入本研究。行^13C—MBT及常规肝功能检测，记录^13C—MBT的3个主要参数Mvmax40、CUM40及CUM120，并绘制DOB曲线、MV曲线。结果（1）健康埘照组、转移性肝癌组、原发性肝癌组的DOB和MV曲线峰形一致，峰值均出现在服药后20min；原发性肝癌组与另外2组比较，DOB和MV曲线的峰值均下降，差异有统计学意义，而转移性肝癌组与健康对照组间的差异无统计学意义。原发性肝癌的A、B、C3个亚组的峰形差异较大，A组为单峰曲线，峰形尖锐；B组峰形相对低平，经过上升相后有1个平台期；C组呈乱峰或锯齿状，无明显排峰。（2）原发性肝癌组与另外两组比较，^13C—MBT的3个参数Mvmax40、CUM40及CUM120的差异有统计学意义（P〈0．05），转移性肝癌组与健康对照组相比，CUM120差异有统计学意义（P〈0．05），Mvmax40、CUM40差异无统计学意义。原发性肝癌A、B、C3个亚组间两两比较，A组的Mvmax40、CUM40与B、C两组的差异有统计学意义（P〈0．05），而B组与C组间差异无统计学意义；CUM120仅在A组与C组间差异有统计学意义（P〈0．05）。（3）相关性分析表明，^13C—MBT的3个参数（Mvmax40、CUM40及CUM120）与总胆汁酸（TBA）呈负相关，与白蛋白（Alb）、前白蛋白（PA）、胆碱酯酶（ChE）呈正相关，与转氨酶（ALT、AST）、总胆红素（TBil）、γ-谷氨酰转肽酶（γ-GT）、碱性磷酸酶（ALP）、凝血酶原时间（Pr）无相关性。（4）^13C—MBT分级与Child—Pugh分级在判定原发性�Objective To investigate the characteristic of ^13C-methacetin breath test （^13C-MBT） as a tool to monitor the hepatic function of patients with hepatic carcinoma by comparing with Child-Pugh classification and general liver function. Methods Thirty-nine patients with primary liver cancer, 16 patients with hepatic metastasis and 14 healthy volunteers serving as controls were included in this study. According to Child-Pagh classification, the primary liver cancer patients were divided into A, B and C subgroups. All subjects received ^13C-MBT and routine liver function tests after an overnight fast. The three major parameters of ^13C-MBT i.e. maximum excretion rate before 40 min （Mvmax40）, L3CO2 cumulative excretion of 40 min（CUM40） and that of 120 min（CUM120） were recorded and the two metabolism curves （ DOB curve, MV curve） were made. Results （ 1 ） In the control, hepatic metastasis and primary liver cancer groups, both the DOB curve and MV curve were similar in shape; the peak time occurred at about 20 rain after administration and then the curves lowered progressively. There were significant differences between the primary liver cancer group and the other two groups, but it was not statistically different between the hepatic metastasis group and the controls. The shape was obviously distinct in the groups A, B and C of primary liver cancer. The group A had a single sharp peak curve, group B a relatively fiat peak curve with a lower level for a long time after the ascending phase and group C no clear excretion peak or even a negative curve. （2） As to the three parameters of ^13C-MBT, there were statistical difference between the primary liver cancer group and the other two groups （ P 〈 0. 05 ）. Between hepatic metastasis group and controls, there was statistical difference about CUM120 （P 〈 0. 05 ）, but no statistical difference about Mvmax40 and CUM40. While in the three groups with primary liver cancer groups, there was statistical difference between group A and B in Mvm

关 键 词：肝肿瘤 肝储备功能 ^13C-美沙西丁呼气试验 

分 类 号：R686[医药卫生—骨科学]