13C-美沙西丁呼气试验对儿童肝脏疾病的诊断价值

13C -methacetin breath test for evaluating of children＇s liver disorder

目的探讨13C-美沙西丁呼气试验对儿童肝脏疾病的诊断价值，并进一步分析其对儿童肝脏功能损害程度的预测价值。方法连续入组40例病因和病情严重程度不同的肝病患儿作为病例组，并将其分为Child—PughA级和B级以下（包括1例c级）两级，分别为28、12例，按随机数字表法选取18例健康体检儿童作为健康对照组。所有受试者口服13C-美沙西丁2mg／kg进行呼气试验肝功能检测，同时常规检测肝功能指标，如血清转氨酶、胆红素、清蛋白和凝血酶原时间等，采用SPSS17．0软件进行统计分析。结果1．病例组13C-美沙西丁呼气试验指标30min前代谢速率峰值（MVmax30）（46．64±27．93）和120min累积丰度（CUM120）（59．29±30．73）显著低于健康对照组（73．56±26．03和102．97±41．80，t=2．450、3．165，P均〈0．05）；2．MVmax30和CUM120与清蛋白、总胆红素、直接胆红素、凝血酶原时间有明显相关性（P〈0．05）；3．MVmax30和CUM120可以很好地预NJL童肝病，CUM120的预测作用更明显，当CUM120=85．80时，约登指数达最大值0．578，此时敏感度为77．8％，特异度为80．0％；4．B级及以下肝病患儿CUM120显著低于A级肝病患JL（P〈0．001）；5．CUM120可以很好地预测肝病患儿肝功能的严重程度，当CUM120=56．15时，约登指数达最大值0．857，此时敏感度为85．7％，特异度为100．0％。结论13C-美沙西丁呼气试验指标CUM120对儿童肝病具有一定的诊断价值，并可以很好地评估肝功能的损害程度。

Objective To explore the clinical value of 13 C - methacetin breath test for the assessment of liver disorder and to analyze its predictive value to the severity of liver function injury in children. Methods Eighteen healthy children served as healthy control group, and 40 patients with different etiology and severity served as experimental group, and then the latter were divided into 2 subgroups ,28 patients in Child - Pugh classification A, and 12 cases in below B （ 11 cases in B and 1 case in C）. An oral dose of 2 mg/kg tracer 13 C -methacetin was administered to each subject for the 13C -methacetin breath test. At the same time, serum liver function markers including serum transaminase, bilirubin, albumin and prothrombin time were measured. The acquired data were analyzed by SPSS 17.0 soft- ware. Results （ 1 ） Metabolisation velocity （MV） max30 and cumulated dose （CUM） 120 in experimental group （46. 64 ± 27.93,59.29 ＋ 30. 73 ） were much lower than those of the healthy control group （73.56 ± 26.03,102.97± 41.80） （t = 2. 450,3. 165, all P 〈 0. 05 ） ; （2） MVmax30 and CUM120 were closely correlated with the liver function markers of albumin, total bihrubin, direct bilirubin, prothrombin time （ P 〈 0.05 ） ; （ 3 ） MVmax30 and CUM120 could predict liver diseases in children,especially the CUM120. With CUM120 = 85.80 as a cut - off value to predict liver diseases ,the Youden index was 0. 578 at its maximum,and the sensitivity and specificity were 77.8% and 80.0% ; （4） Compared with the Child -Pugh classification A,the CUM120 in Child -Pugh classification B and lower B was significandy lower（P 〈 0. 001 ） ; （5） CUM120 could predict the severity of liver diseases. With CUM120 = 56.15 as a cut - off value to predict the severity of liver diseases,the Youden index was 0. 857 at its maximum, and the sensitivity and specificity were 85.7% and 100.0%. Conclusion 13C - methacetin breath test index of CUM120 could predict liver diseases in children and the severity of liver function.