IRIS13C-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

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。

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

Objective To investigate the clinical value of the 13C-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),13CO2 cumulative excretion of 40 min(CUM40) and 120 min(CUM120) and used in a comparative analysis to determine association with Child-Pugh score,MELD score,liver and spleen volume(assessed by computed tomography),and liver function parameters(assessed 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(κ=0.57,P<0.05) and MELD classification(κ=0.41,P<0.05).In cirrhosis patients,the 13C-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.