^13C-美沙西汀呼气试验评估早期重症肝病患者血浆置换前后肝储备功能的变化

Evaluation the liver reservation functions of patients with severe hepatopath of nonage treated with plasma exchange by ^13 C-methacetin breath test.

目的通过^13C-美沙西汀呼气试验评估早期重症肝病患者血浆置换前后肝储备功能的变化，判断血浆置换的疗效。方法治疗组和对照组患者各30例，均给予药物和支持治疗，治疗组同时行血浆置换，于治疗前及治疗1周时行^13C-美沙西汀呼气试验，记录40min前代谢速率峰值（MVmax40）、40min ^13CO2累积呼出丰度（CUM40）和120min^13CO2累积呼出丰度（CUM120），同时观察患者临床症状、血清ALT和总胆红素（TBiL）及血浆凝血酶原活动度（WA）的变化。结果治疗组治疗前后MVmax40分别为（6．46±1．17）％与（8．04±2．93）％，CUM40分别为（3．00±0．66）％与（3．77±1．47）％，CUM120分别为（6．93±1．36）％与（8．97±3．51）％，PTA分别为（34．6±2．5）％与（45．5±12．9）％，ALT分别为（538．1±136．4）U／L与（314．2±213．3）U／L，TBiL分别为（401．2±62．6）μmol／L与（218．3±160．5）μmol／L；治疗组治疗后较治疗前MVmax40（t=4．679）、CUM40（t=4．752）、CUM120（t=5．048）及PTA（t=5．413）显著提高（P均〈0．01）；ALT（t=6．208）和TBiL（t=7．413）显著降低（P均〈0．01）；治疗组治疗后较对照组[MVmax40（6．47±2．43）％，CUM40（2．99±1．21）％，CUM120（6．98±2．67）％，PTA（33．8±9．3）％，ALT（496．9±222．2）U／L，TBiL（374．5±170．1）μmol／L]更有效升高MVmax40（t=2．260）、CUM40（t=2．247）、CUM120（t=2．476）及PTA（t=4．017），降低ALT（t=3．250）和TBiL（t=3．658，P均〈0．05）；治疗组总有效率为83．3％（25／30），对照组为43．3％（13／30），2组比较差异有统计学意义（χ^2=10．335，P〈0．01）。结论早期重症肝病患者血浆置换后肝储备功能有显著改善，血浆置换是治疗早期重症肝病的有效方法。

Objective To judge the effect of plasma exchange （PE） to the patients with severe hepatopath of nonage according to evaluating the change of the liver function of reserve with ^13 C-methacetin breath test. Methods There are two groups： the case group and the control group. Each group has 30 patients. The patients in the case group were treated by PE. All the patients received ^13C-methacetin breath test at before or one week after treatment. MVmax40, CUM40 and CUM120 were present. At the same time, clinical symptoms, glutamate-pyruvate transaminase （ALT） , total bilirubin （TBiL） and prothrombin active （PTA） were observed. Results MVmax40, CUM40, CUM120 and PTA were higher, ALT and TBiL were lower in the case group after treatment （ t = 4. 679, 4. 752, 5. 048, 5. 413, 6. 208, 7.413, P = 0. 000,P 〈 0.01 ）. After a week, MVmax40, C UM40, C UM120 and PTA were higher, ALT and TBiL were lower in the case group than that in the control group （ t = 2. 260, 2. 247, 2. 476, 4. 017, 3. 250, 3. 658, P 〈 0.05）. The total effective rates in the case group and the control group were 83.3 % （25/30） and 43.3 % （13/30） ,which are significant different （χ^2 = 10. 335, P 〈 0.01 ）. Conclusion PE can improve the liver reservation funetionin the severe hepatopath of nonage.