Clinical value of 13C-methacetin breath test for assessing liver function in patients with cirrhosis
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摘要: 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...
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关键词:
- 13C-美沙西汀呼气试验 /
- 肝脏储备功能 /
- Child-Pugh分级 /
- MELD评分 /
- 肝硬化
Abstract: 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. -
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