基于红外线同位素能谱分析仪的^(13)C-MBT对非酒精性脂肪肝病患者肝功能储备的无创评估  

Noninvasive assessment of liver function reserve in NAFLD patients by ^(13)C-MBT based on infrared isotope spectrometry

作　　者：文倩[1] 咸亚静 杨丽[1] 柯华[1] 杜璐璐[1] 林栋羚[1] Wen Qian;Xian Yajing;Yang Li;Ke Hua;Du Lulu;Lin Dongling(Department of the First Section of Liver Diseases of Infectious Diseases,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院感染病肝病一科,乌鲁木齐830000

出　　处：《中国医学装备》2025年第1期76-81,共6页China Medical Equipment

基　　金：新疆维吾尔自治区自然科学基金(2021D01C270)。

摘　　要：目的:探讨基于红外线同位素能谱分析仪的^(13)C-嘧噻西啶呼气试验(^(13)C-MBT)对非酒精性脂肪肝病(NAFLD)患者肝功能储备的无创评估价值。方法:前瞻性选取2023年1月至2024年1月在新疆医科大学第一附属医院肝病科就诊的120例符合诊断标准的NAFLD患者,根据肝脏瞬时弹性成像(FibroTouch)检测的肝脏硬度测量值(LSM)将其分为轻度纤维化组(LSM<7.0 kPa,40例)、中度纤维化组(7.0≤LSM<9.5 kPa,40例)和重度纤维化组(LSM≥9.5 kPa,40例);同时选取40例健康体检者作为健康对照组。所有受试者均接受^(13)C-MBT和常规肝功能检测,比较各组间的^(13)C-MBT的参数和肝功能指标的差异,并分析^(13)C-MBT的参数与肝功能指标和肝纤维化程度的相关性。采用受试者工作特征(ROC)曲线分析评价^(13)C-MBT的参数对肝纤维化程度的判断效能。结果:NAFLD患者的^(13)C-MBT的40 min最大代谢速率峰值(MVmax40)、40 min和120 min代谢速率累计值(CUM40和CUM120)均低于健康对照组,差异有统计学意义(F=27.413、28.635、29.851,P<0.05)。随着肝纤维化程度的加重,NAFLD患者的^(13)C-MBT参数逐渐降低,重度纤维化组的^(13)C-MBT的参数均低于轻度纤维化组和中度纤维化组,差异有统计学意义(t=12.331、13.020、14.232、22.033、21.032、29.332,P<0.05)。^(13)C-MBT参数与肝功能指标呈正相关,与LSM呈负相关,相关系数的绝对值均>0.5,差异均有统计学意义(r=0.375~0.875,P<0.05)。^(13)C-MBT参数对肝纤维化程度的判断具有较高的敏感性和特异性,以MVmax40为例,当以9.5 kPa为界限值时,其灵敏度为86.3%,特异度为83.8%,准确率为85.0%,ROC曲线下面积(AUC)为0.913。结论:基于红外线同位素能谱分析仪的^(13)C-MBT是一种无创、安全、快速、准确的检测方法,能够反映NAFLD患者的肝功能储备和肝纤维化程度,对NAFLD的诊断和治疗具有重要的临床价值。Objective:To evaluate the value of noninvasive assessment of the ^(13)C-methacetin breath test(^(13)C-MBT)based on infrared isotope spectrometry for liver function reserve in patients with nonalcoholic fatty liver disease(NAFLD).Methods:A total of 120 NAFLD patients met the diagnostic criteria,who admitted to Department of Liver Diseases of the First Affiliated Hospital of Xinjiang Medical University from January 2023 to January 2024,were prospectively selected.Patients were divided into three groups based on liver stiffness measurement(LSM)of FibroTouch:mild fibrosis group(LSM<7.0 kPa,n=40),moderate fibrosis group(7.0≤LSM<9.5 kPa)and severe fibrosis group(LSM≥9.5 kPa,n=40).Meanwhile,40 healthy subjects were selected as a healthy control group.All subjects underwent ^(13)C-MBT and conventional liver function tests.The differences of ^(13)C-MBT parameters and liver function indicators among various groups were compared,and the correlations between ^(13)C-MBT parameters and the degree of liver fibrosis,and between liver function indexes and the degree of liver fibrosis were analyzed.Receiver operating characteristic(ROC)curve was used to evaluate the judgment ability of ^(13)C-MBT parameters to the degree of liver fibrosis.Results:The ^(13)C-MBT parameters in NAFLD patients were lower than those in healthy control group,and the differences were statistically significant(F=27.413,28.635,29.851,P<0.05).With the aggravation of liver fibrosis,^(13)C-MBT parameters in NAFLD patients gradually decreased.The ^(13)C-MBT parameters of severe fibrosis group were significantly lower than those in the mild and moderate fibrosis groups,with statistically significant differences(t=12.331,13.020,14.232,22.033,21.032,29.332,P<0.05),respectively.The ^(13)C-MBT parameters were positively correlated with liver function indicators,and were negatively correlated with LSM,and the absolute values of the correlation coefficients were>0.5,all of them showed statistically significant differences(r=0.375,-0.875,P<0.05).The ^(13)C-MBT par

关 键 词：非酒精性脂肪肝病 ^(13)C-嘧噻西啶呼气试验 肝功能储备 肝纤维化 红外线同位素能谱分析仪 超声弹性成像 

分 类 号：R575[医药卫生—消化系统]