13C-美沙西丁呼气试验检测肝癌肝动脉化疗栓塞术后肝储备功能的研究

 目的　分析原发性肝癌患者13C-美沙西丁呼气试验（13C-MBT）不同量化分级肝动脉化疗栓塞术（TACE）前后肝功能变化情况，为TACE提供风险预测。方法　选择原发性肝癌患者28例，转移性肝癌患者10例，所有病例行一般肝功能项目检测和13C-MBT测定。根据13C-MBT结果把原发性肝癌分为4组（1组为正常和病理性肝损害，2组为A级，3组为B级，4组为C级）。在TACE后1、4周再次行13C-MBT检测。结果　转移性肝癌TACE术后1周40 min前代谢速率峰值／27（MVmax40）、40 min 13CO2累积呼出丰度／12（CUM40）、120 min 13CO2累积呼出丰度／28（CUM120）三参数[（0.600±0.187）%，（0.559±0.189）%，（0.587±0.181）%]、4周三参数[（0.700±0.230）%，（0.734±0.229）%，（0.724±0.252）%]与TACE前三参数[（0.628±0.191）%，（0.628±0.289）%，（0.577±0.286）%]比较差异无统计学意义。根据13C-MBT量化分级观察原发性肝癌不同肝功能状态下TACE后13C-MBT三参数的变化， 不同组患者随着时间的变化，曲线变化幅度有所区别，1、2、3组介入术后4周与术前无差异，4组介入术后4周恢复差。结论　13C-MBT量化分级越差，TACE后肝损害越重，13C-MBT可为临床肝癌介入治疗提供依据。

The study of reserved liver function after TACE in hepatic carcinoma by 13C-methacetin breath test

Objective To investigate the changes of hepatic function before and after transcatheter arterial chemoembolization (TACE) in primary liver cancer patients with different quantifications and classifications using 13C-methacetin breath test (13C-MBT), and to provide risk predicts for TACE. Methods 28 cases of primary liver cancer patients and 10 cases of metastatic liver cancer patients were selected.General examination items of liver function and 13C-MBT detection were performed on all cases. Primary liver cancer was divided into 4 groups according to the results of 13C-MBT (group 1 was normal or pathological liver damage; group 2 was grade A; Group 3 was grade B; group 4 was grade C). 13C-MBT detection was carried out in week 1 and 4 after TACE. Results The three parameters of 13C-MBT is 13CO2 maximum excretion rate before 40 min/27 (MVmax40), 13CO2 cumulative excretion of 40 min/12 (CUM40), and than of 120 min/28(CUM120). Compared with the parameters [(0.628±0.191)%, (0.628±0.289)%, (0.577±0.286)%] before TACE in hepatic metastasis, there were no statistic effect between week 1 [(0.600±0.187)%, (0.559±0.189)%, 0.587±0.181)%] and week 4 [(0.700±0.230)%, (0.734±0.229)%, (0.724±0.252)%] after TACE. Conclusion The lower classification of 13C-MBT, the more impairment to liver function after TACE. This could provide an important diagnostic basis for TACE.