^(13)C-美沙西丁呼气试验联合血清胰岛素样生长因子及其结合蛋白测定对肝硬化患者肝功能状况的评估

Value of ^(13)C-methacetin-breath test and serum insulin-like growth factor and its binding protein-3 in liver function tests in patients with liver cirrhosis

目的 探讨13 C 美沙西丁呼气试验联合血清胰岛素样生长因子 1(insulinlikegrowthfactor 1,IGF 1)、胰岛素样生长因子结合蛋白。 3 (insulin likegrowthfactorbindingprotein 3 ,IGFBP 3 )测定对肝硬化患者肝功能状况评估的临床意义。方法 随机选取肝炎后肝硬化 14例 ,隔夜空腹 ,服用13 C 美沙西丁 75mg后 ,通过13 C红外线能谱分析仪检测 10个时间段呼出碳 13的含量 ,得出Mvmax40 ( 4 0分钟前13 C代谢速率峰值与正常值的比值 )、CUM 40 ( 4 0分钟13 CO2 累积呼出丰度与正常值的比值 )及CUM 12 0 ( 12 0分钟13 CO2累积呼出丰度与正常值的比值 ) ,并同步采用免疫放射法定量测定血清IGF 1、IGFBP 3水平。结果 肝硬化患者Mvmax 40、CUM 40、CUM 12 0值 ,在ChildA、B、C各组间 ,除A组与B组的CUM 12 0值外 ,差异有显著性 (P <0 .0 5 )。IGF 1,IGFBP 3值在ChildA、B、C组间除ChildA组与B组间外 ,差异有显著性 (P <0 .0 5 )。13 CMvmax 40、CUM 40、CUM 12 0及IGF 1、IGFBP 3值与Childpugh积分呈明显负相关 (r =-0 .881,-0 .878,-0 .83 3 ,-0 .70 0 ,-0 .815 ) ,13 CMvmax 40、CUM 40、CUM 12 0值与IGF 1、IGFBP 3值呈明显正相关。结论 13

Objective To investigate the significance of united determillaLk liver function using 13C-methacetin breath test and insulin-like growth factor-1 (IGF-1),insulin-like growth factor binding protein-3 (IGFBP-3) in liver cirrhosis. Methods Fourteen patients with liver cirrhosis after hepatitis B were enrolled. After oral administration of 13C-methacetin(75 mg),enrichment of breath 13CO 2 of patients were measured by isotope ration infared spectroscopy and 13C Mvmax 40,CUM 40,CUM 120 were gotten.At the same time,IGF-1 and IGFBP-3 were detected.Results the difference of 13C Mvmax 40,CUM 40 among Child-pugh A,B and C groups is notable (P<0.05),and the difference of CUM 120 is very notable between Child-pugh A or B and C group (P<0.01).The difference of IGF-1 and IGFBP-3 of patients among child A,B and C groups is notable (P<0.05)except between child A and B group. 13C Mvmax 40,CUM 40 or CUM 120 and IGF-1 and IGFBP-3 of patients were negative correlative with Child-pugh score(r=-0.881,-0.878,-0.833,-0.700,-0.815). 13C Mvmax 40,CUM 40 and CUM 120 of patients had postive correlation with IGF-1 and IGFBP-3.Conclusion The result show that 13C-Methacetin-breath test could act as a marker that could be used to measure immediate reserve liver function and compensate liver funtion,and could act as clinical complement with IGF-1 and IGFBP-3.