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IRIS13C-美沙西汀呼气试验与Child-Pugh分级、MELD评分评估肝硬化患者肝功能的比较
Clinical value of 13C-methacetin breath test for assessing liver function in patients with cirrhosis
文章发布日期:2012年08月15日  来源:  作者:刘 芳 向慧玲 韩 涛等  点击次数:6596次  下载次数:552次

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【摘要】:目的 通过比较肝硬化患者13C-美沙西汀呼气试验、Child-Pugh分级及MELD评分,结合腹部CT测量肝脾体积以探讨13C-美沙西汀呼气试验评价肝脏储备和代偿功能的临床应用价值。方法 139例肝硬化患者行13C-美沙西汀呼气试验、Child-Pugh分级及MELD评分,分析各组13C-美沙西汀呼气试验的呼气参数值之间的相互关系,比较乙型肝炎肝硬化患者肝脏、脾脏体积变化以进一步评估13C-美沙西汀呼气试验反映肝细胞储备和代偿功能的作用。结果 13C-美沙西汀呼气试验肝脏功能分级与肝硬化患者传统的Child-Pugh分级判定肝功能状况具有良好一致性(κ=0.55,P<0.05),与MELD评分比较具有一致性(κ=0.41,P<0.05);肝脏病变程度越重,13C-美沙西汀呼气试验量化值越小, 肝硬化患者呼气参数值显著下降(P<0.05),肝细胞储备和代偿功能越差;呼气试验参数与Child -Pugh分级计分、MELD评分、血清总胆红素、国际标准化比值(INR)呈明显负相关(P<0.01),与血清白蛋白、前白蛋白、凝血酶原活动度、胆碱酯酶呈正相关(P<0.01),与肝硬化患者脾脏体积呈负相关(P<0.05),与血肌酐、ALT、肝脏体积无显著相关性(P>0.05)。68例乙型肝炎肝硬化患者中Child-Pugh分级、MELD评分越高,肝脏体积越小;13C-美沙西汀呼气试验量化值与乙型肝炎肝硬化患者肝脏体积呈正相关(P<0.05)。结论 IRIS13C(红外线同位素13C)-美沙西汀呼气试验可准确反应肝硬化患者肝脏储备及代偿功能。
【Abstract】:Objective To investigate the clinical value of the 13C-methacetin breath test (MBT) for assessing liver function in patients with cirrhosis. Methods One-hundred-thirty-nine patients with liver cirrhosis, 34 hepatitis patients, and 22 healthy controls were studied. Patients with cirrhosis were divided into groups according to Child-Pugh score and model of end-stage liver disease (MELD) score. All study participants underwent 13C-MBT. The three major parameters of 13C-MBT were recorded (maximum excretion rate before 40 min (MVmax40), 13CO2 cumulative excretion of 40 min (CUM40) and 120 min (CUM120) and used in a comparative analysis to determine association with Child-Pugh score, MELD score, liver and spleen volume (assessed by computed tomography), and liver function parameters (assessed by standard biochemical assays). Results As severity of liver damage increased, the MVmax40, CUM40, and CUM120 decreased. The 13C-MBT classification was consistent with Child-Pugh classification (κ=0.57, P<0.05) and MELD classification (κ=0.41, P<0.05). In cirrhosis patients, the 13C-MBT parameters were negatively correlated with Child-Pugh score, MELD score, total bilirubin, international normalized ratio, and spleen volume (all P<0.01), but positively correlated with albumin, prealbumin, prothrombin time activity, and serum cholinesterase (all P<0.05), and not correlated with creatinine, alanine aminotransferase, or liver volume (all P>0.05). In 68 patients with hepatitis B virus infection and cirrhosis, the liver volumes were obviously reduced with increasing Child-Pugh score and MELD score. The 13C-MBT parameters were positively correlated with liver volume. Conclusion The 13C-methacetin breath test is a useful tool to measure the extent of hepatocyte injury and liver functional reserve.
【关键字】:13C-美沙西汀呼气试验;肝脏储备功能;Child-Pugh分级;MELD评分; 肝硬化
【Key words】:13C-methacetin breath test; liver functional reserve; Child-Pugh classification; model for end-stage liver disease; liver cirrhosis
【引证本文】:

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