13C-美沙西丁呼气试验在老年肝硬化患者肝储备功能评估中的应用  

The application of 13C-methacetin breath test in the assessment of the reserved liver function in elderly patients with cirrhosis

作　　者：刘磊[1] 阚志超[1] 李岩[1] 肖时湘[1] 刘华[1] 李莹[1] 陈英[1] 庄茗[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,300170

出　　处：《中华老年医学杂志》2014年第7期764-767,共4页Chinese Journal of Geriatrics

摘　　要：目的 探讨应用13C-美沙西丁呼气试验（13C-MBT）评估老年肝硬化患者的肝功能储备的作用. 方法 选取老年肝硬化患者147例,肝功能Chid-Pugh A级53例,Chid-Pugh B级44例,Chid-Pugh C级50例.同时选取老年慢性肝炎患者26例及健康老年志愿者1 5例作为对照.行13C MBT、肝功能、肾功能、凝血功能检测,计算Chid-Pugh计分,绘制丰度曲线、代谢速率曲线;分析13C MBT的主要参数与常规肝功能指标之间的关系. 结果 老年健康对照组、慢性肝炎组及肝硬化组患者随肝脏疾病的进展,13C MBT的主要参数值逐渐下降,13C-MBT肝功能分级与Child-Pugh分级判定肝硬化患者肝功能状况一致率为87.8％（kappa=0.82,P＜0.01）.肝硬化患者13C MBT参数值与丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转移酶（GGT）无相关性（P＞0.05）,与血清白蛋白、凝血酶原活动度呈正相关（P＜0.01）,与血清总胆红素、Child-Pugh计分呈负相关（P＜0.01）. 结论 13C-MBT是一种能够反映老年肝硬化患者肝细胞储备功能安全、无创的检查方法,是临床肝功能生化检测、Child-Pugh分级评价肝功能的有益补充.Objective To investigate whether the 13C methacetin breath test（13C-MBT） could be useful for the evaluation of hepatic function in elderly patients with cirrhosis.Methods One hundred and seven patients with cirrhosis were enrolled in this study.Patients with cirrhosis were divided into three groups according to Child Pugh classification：53 patients with Child Pugh A were considered as group A,44 patients with Child-Pugh B were as group B,and 50 patients with ChildPugh C were as group C.26 patients with chronic hepatitis and 15 elderly healthy subjects were served as controls.All subjects performed 13C-MBT,routine liver function,renal function and coagulation test.Meanwhile Child-Pugh scores were calculated.Abundance curve and metabolic rate curve were plotted.The correlations between breath test parameters and liver function parameters were analyzed.Results In the elderly healthy subjects and patients with chronic hepatitis and patients with liver cirrhosis,the breath test parameters decreased gradually along with the progress of liver disease.The concordance rate between 13C-methacetin breath test classification and Child-Pugh classification was 87.8％ （kappa=0.82,P＜0.01）.In cirrhotic patients,the parameters of 13C-MBT were negatively correlated with serum total bilirubin,Child-Pugh score （both P＜0.01）,positively with prothrombin time activity （PTA） and serum albumin （ALB） （both P＜0.01）,but were not correlated with alanine aminotransferase （ALT）,aspartate aminotransferase （AST）,alkaline phosphatase （ALP） and γ-glutamyltransferase （GGT） （all P＞0.05）.Conclusions The 13C methacetin breath test is a safe and non-invasive assay to evaluate the reserved hepatic function in elderly patients with cirrhosis.It is a better supplementary method for the routine liver function test and Child-Pugh score system.

关 键 词：肝硬化 肝功能试验 

分 类 号：R575.2[医药卫生—消化系统]