IRIS13C-美沙西汀呼气试验对肝功能检测临床价值与预后评估

目的探讨红外线同位素能谱分析仪(IRIS)13C-美沙西汀呼气试验在肝硬化肝功能分级及预后评估应用中的价值.方法选取肝硬化患者59例作为研究对象,健康志愿者12例作为正常对照组,进行13C-美沙西汀呼气试验肝功能检测并与Child-pugh肝功能分级进行比较,随访半年观察病情预后.结果①13C-美沙西汀呼气试验mvmax40值、cum40值及cum120值在对照组、Child-pugh A、B、C组间依次降低,组间差异均有显著性(P＜0.01),且与Child-pugh肝功能分级具有显著负相关性(r值分别为-0.562,-0.614和-0.716,P＜0.001).②13C-美沙西汀呼气试验与Child-pugh肝功能分级判定肝硬化患者肝功能状况具有一致性(Kappa=0.69,P＜0.05).③预后:13C-分级为一级(包括亚病理性肝损害3例)22例均预后良好;13C-分级为二级的14例中,2例死于上消化道大出血;13C-分级为三级的11例中5例分别先后死于肝昏迷、肝肾综合征及感染性休克.结论13C-美沙西汀呼气试验作为一种灵敏、定量的肝功能试验可用于肝硬化患者的肝功能状况分级并有助于本病手术选择与预后评估.

The clinical value of IRIS13C-methacetin breath test in assessment of liver function and prognostic prediction in patients with cirrhosis

Objective To investigate the clinical value of 13C-methacetin breath test in the assessment of liver function and prognostic prediction in patients with cirrhosis. Methods Twelve healthy volunteers served as controls. Fifty-nine patients with liver cirrhosis received 13C-methacetin breath test and Child-pugh classification at the same time, then the differences in the assessment of liver function in patients with cirrhosis was compared.Follow_up was conducted for 6 months to obeserve the prognosis of these patieats. Results (1) 13C-mv_ max40,cum_ 40 and cum_ 120 for the normal controls,Child-pugh A, B and C groups were decreased gradually and there were significant differences between any two groups (P<0.01), and they were negatively correlated with Child-pugh classification score significantly (r=-0.562,-0.614,-0.716, P<0.001). (2) 13C-methacetin breath test was consistent with Child-pugh classification (Kappa=0.69, P<0.05) in the assessment of liver function in patients with cirrhosis. (3) Twenty_two patients grade one determined by 13C-methacetin breath test was alive. Two of 14 patients grade two died of upper gastrointestinal hemorrhage and 5 of thirteen patients grade three died of hepatorenal syndrome, hepatic encephalopathy and infective shock respectively. Conclusion As a sensitive and quantitive liver function test method, 13C-methacetin breath test can be used to assess the state of liver function,the prognosis of liver cirrhosis patients.