^(13)C-美沙西丁呼气试验判断肝硬化患者肝功能

Evaluation of hepatic function with ^(13)C-methacetin breath test in patients with liver cirrhosis

目的:探讨肝硬化患者13C-美沙西丁肝功能呼气试验检测的特点. 方法:肝硬化患者42例和正常人31名进行13C-美沙西丁呼气试验.口服13C-美沙西丁75 mg,收集检测并比较研究对象服药前、服药后10,20,30,40,50,60,80,100, 120 min等10个时间段呼出气体中13CO2丰度(DOB)、代谢速率(MV)以及累积丰度(CD)等. 结果:正常人呼出气体中13CO2丰度有明显的峰值(20.3±3.5%),出现在服用13C-美沙西丁后20 min左右;Child A 级患者为低平双峰峰值,分别出现在20 min和80 min (7.5±1.8%和6.5±3.3%);Child B级患者峰值后移至40 min(4.6±1.3%);各组间峰值差别均有显著统计学意义(P<0.05),Child C级患者无峰值.正常人和Child A级患者代谢速率最高峰出现在20 min(28.8±5.3%和9.4±2.4%), 差别有统计学意义(P<0.05),而Child B级患者代谢速率普遍降低且无峰值,Child C级患者代谢速率极低.正常人、Child A级、Child B级、Child C级患者120 min 13CO2累积呼出丰度依次分别为31.2±4.5%,13.8±3.7%, 8.2±2.2%,2.4±0.8%,各组间差异显著(P<0.05). 结论:13C-美沙西丁呼气试验检测能准确、直观地反映肝硬化患者肝功能状况.

AIM: To investigate the characteristics of the 13C-methacetin breath test (13C-MBT) as a tool to monitor hepatic function of patients with liver cirrhosis. METHODS: Forty-two patients with liver cirrhosis and thirty-one age- and sex-matched healthy controls underwent 13C-MBT. 13C-methacetin (75 mg) was given orally, and the levels of 13CO2 delta over baseline (DOB), metabolisation velocity (MV) and cumulative percentage doses (CD) before and 10, 20, 30, 40, 50, 60, 80, 100 and 120 min after substrate administration breath samples was determined and compared, by non-dispersive infrared spectrometry. RESULTS: The 13CO2 peak percent doses of healthy controls, Child class A and Child class B patients were 20.3 ± 3.5%, 7.5 ± 1.8% or 6.5 ± 3.3% and 4.5 ± 1.3%, and occurred at 20 min, 20 or 80 min and 40 min, respectively. The differences of 13CO2 peak percent doses among healthy controls, Child class A and Child class B patients were obvious (P<0.05). No 13CO2 peak percent doses occurred in Child class C patients. The differences of 13CO2 peak metabolic velocity were obvious (P<0.05) between healthy controls (28.8 ± 5.3%) and Child class A patients (9.4 ± 2.4%). No 13CO2 peak metabolic velocity occurred in Child class B and Child class C patients. The 13CO2 cumulative percentage doses of healthy controls, Child class A, Child class B and Child class C patients at 120 min after substrate administration were 31.2 ± 4.5%, 13.8 ± 3.7%, 8.2 ± 2.2% and 2.4 ± 0.8% (P<0.05), respectively. CONCLUSION: The severity of liver damage can be directly and effectively evaluated by 13C-MBT in patients with cirrhosis.