IRIS^13C-美沙西汀呼气试验与Child-Pugh分级、MELD评分评估肝硬化患者肝功能的比较  

Clinical value of ^(13)C-methacetin breath test for assessing liver function in patients with cirrhosis

作　　者：刘芳[1] 向慧玲[1] 韩涛[1] 张翔[1] 

机构地区：[1]天津市第三中心医院肝内科天津市肝胆疾病研究所天津市人工细胞重点实验室,天津300170

出　　处：《临床肝胆病杂志》2012年第9期661-666,共6页Journal of Clinical Hepatology

摘　　要：目的通过比较肝硬化患者13C-美沙西汀呼气试验、Child-Pugh分级及MELD评分,结合腹部CT测量肝脾体积以探讨13C-美沙西汀呼气试验评价肝脏储备和代偿功能的临床应用价值。方法 139例肝硬化患者行13C-美沙西汀呼气试验、Child-Pugh分级及MELD评分,分析各组13C-美沙西汀呼气试验的呼气参数值之间的相互关系,比较乙型肝炎肝硬化患者肝脏、脾脏体积变化以进一步评估13C-美沙西汀呼气试验反映肝细胞储备和代偿功能的作用。结果13C-美沙西汀呼气试验肝脏功能分级与肝硬化患者传统的Child-Pugh分级判定肝功能状况具有良好一致性(κ=0.55,P<0.05),与MELD评分比较具有一致性(κ=0.41,P<0.05);肝脏病变程度越重,13C-美沙西汀呼气试验量化值越小,肝硬化患者呼气参数值显著下降(P<0.05),肝细胞储备和代偿功能越差;呼气试验参数与Child-Pugh分级计分、MELD评分、血清总胆红素、国际标准化比值(INR)呈明显负相关(P<0.01),与血清白蛋白、前白蛋白、凝血酶原活动度、胆碱酯酶呈正相关(P<0.01),与肝硬化患者脾脏体积呈负相关(P<0.05),与血肌酐、ALT、肝脏体积无显著相关性(P>0.05)。68例乙型肝炎肝硬化患者中Child-Pugh分级、MELD评分越高,肝脏体积越小;13C-美沙西汀呼气试验量化值与乙型肝炎肝硬化患者肝脏体积呈正相关(P<0.05)。结论 IRIS13C(红外线同位素13C)-美沙西汀呼气试验可准确反应肝硬化患者肝脏储备及代偿功能。Objective To investigate the clinical value of the ^13 C- methacetin breath test （MBT） for assessing liver function in patients with cirrhosis. Methods One - hundred - thirty - nine patients with liver cirrhosis, 34 hepatitis patients, and 22 healthy controls were studied. Patients with cirrhosis were divided into groups according to Child - Pugh score and model of end - stage liver disease （ MELD ） score. All study participants underwent ^13C -MBT. The three major parameters of ^13C -MBT were recorded （maximum excretion rate before 40 min （MVmax40 ） , ^13C02 cumulative excretion of 40 min （CUM40） and 120 min （CUM120 ） and used in a comparative analysis to determine associa- tion with Child - Pugh score, MELD score, liver and spleen volume （ assessed by computed tomography）, and liver function parameters （ as- sessed by standard biochemical assays）. Results As severity of liver damage increased, the MVmax40, CUM40, and CUM120 decreased. The ^13C - MBT classification was consistent with Child - Pugh classification （ K = 0.57, P 〈 0.05 ） and MELD classification （ K = 0.41, P 〈 0.05 ）. In cirrhosis patients, the ^13 C - MBT parameters were negatively correlated with Child - Pugh score, MELD score, total bilirubin, international normalized ratio, and spleen volume （all P 〈 0.01 ）, but positively correlated with albumin, prealbumin, prothrombin time activity, and serum cholinesterase （all P 〈0.05）, and not correlated with creatinine, alanine aminotransferase, or liver volume （all P 〉 0.05 ）. In 68 patients with hepatitis B virus infection and cirrhosis, the liver volumes were obviously reduced with increasing Child - Pugh score and MELD score. The ^13C - MBT parameters were positively correlated with liver volume. Conclusion The ^13C - methacetin breath test is a useful tool to measure the extent of hepatocyte injury and liver functional reserve.

关 键 词：13C-美沙西汀呼气试验 肝脏储备功能 CHILD-PUGH分级 MELD评分 肝硬化 

分 类 号：R575.2[医药卫生—消化系统]