IRIS^(13)C-美沙西汀呼气试验对肝硬化患者肝功能状况临床价值分析

The clinical value of IRIS^( 13)C-methacetin breath test in assessing the state of liver function in patients with cirrhosis

目的:探讨13C-美沙西汀呼气试验(13C-MBT)对肝硬化患者的临床应用价值。方法:选取116例肝硬化患者作为观察对象,常规行肝功能检查,进行13C-MBT肝功能检测并与Child-Pugh临床分级进行比较。对所有研究对象随访半年,观察预后。结果:随着Child-Pugh分级的加重,DOB、MV峰值逐渐降低,峰值时间明显延长,13C-MBT的MVmax40、CUM40和CUM120值随着肝功能损害的加重而显著降低,组间的差异有显著性(P<0.05),PT、TBA与DOB、MV峰值时间呈正相关,与其余参数呈负相关;ALB与DOB、MV峰值时间呈负相关,与其余参数呈正相关。13C-MBT肝功能分级与传统的Child-Pugh临床分级具有一致性(Kappa值0.72,P<0.05)。随访的结果显示,13C-MBT分级A级的患者无观察对象死于肝脏相关的疾病,B级患者3例死亡,死亡率为7.9%,而13C-MBTC级患者的死亡率高达38.1%,患者先后死于上消化道出血、肝性脑病、肝肾综合征、腹膜炎等。结论:13C-MBT是一种有效的肝硬化肝功能分级方法,能够准确反映肝细胞损伤情况和肝脏的储备功能,可用于评估肝硬化患者肝功能状况和预后判断。

Objective： To investigate the clinical value of IRIS ^13C-methacetin breath test in assessment of liver function in patients with liver cirrhosis. Methods： One hundred and sixteen patients with liver cirrhosis were observed. There patients received liver functional test, ^13C-methacetin breath test and the Child-Pugh classification at the same time. All the subjects were followed up for 6 months to observe the prognosis. Results： According to the severity of Child-Pugh classification, the time to maximum appearance of ^13CO2 was delayed and the maximum excretion rate was reduced. The MVmxx40 ,CUM40 and CUM120 were obviously reduced as the liver damage became severity, and there were significantly different among the cirrhosis patients in different Child-Pugh grade （A,B,C, P〈0.05）. The time to maximum and the maximum excretion rate were positively correlated with PT ,TBA and negatively correlated with ALB. The results also showed the consistence of ^13C-MBT classification with Child-Pugh classification （Kappa： 0.72, P〈0.05）. there was no patient death in grade A of ^13C-MBT during follow-up, but the death rate was 7. 9% in grade B and 38. 1% in ^13C-MBT grade C. The patients died of upper gastrointestinal hemorrhage,hepatic encephalopathy,hepato-renal syndrome, peritonitis and so on. Conclusion： ^13C-MBT is an efficient method for the classification of the liver function in cirrhosis. The test can be used reliably to measure the hepatocyte injure and liver functional reserve. It also can be used to assess the state of liver function and the prognosis of liver cirrhosis patients.