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

刘芳; 向慧玲; 韩涛; 张翔

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

天津市第三中心医院肝内科天津市肝胆疾病研究所天津市人工细胞重点实验室

详细信息

中图分类号: R575.2
计量
- 文章访问数: 24749
- HTML全文浏览量: 432
- PDF下载量: 1318
- 被引次数: 0
出版历程
- 出版日期: 2012-09-20

Clinical value of 13C-methacetin breath test for assessing liver function in patients with cirrhosis

摘要

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...
- 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
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.
- 13C-methacetin breath test /
- liver functional reserve /
- Child-Pugh classification /
- model for end-stage liver disease /
- liver cirrhosis

HTML全文

参考文献(25)

[1]蒋忠胜, 江建宁.CTP和MELD评分预测慢性重型肝炎预后的临床价值[J].中国危重病急救医学, 2007, 19 (3) :412-415.

[2]占国清, 郑三菊, 朱琳, 等.终末期肝病模型及Child-Pugh分级对失代偿期肝硬化患者的预后分析[J].临床肝胆病杂志, 2007, 25 (2) :114-116.

[3]刘斌, 亓玉忠, 刘佳宁, 等.MELD评分对肝硬化患者腹腔镜胆囊切除术手术风险的预测价值[J].中国普通外科杂志, 2010, 19 (2) :172-175.

[4]吕晓辉, 刘红波, 宋敏, 等.终末期肝病模型对失代偿期肝硬化患者预后的回顾性分析[J].世界华人消化杂志, 2007, 15 (9) :960-963.

[5]赵玉石, 韩德恩, 邰升, 等.MELD评分评估肝硬化肝功能储备力的临床研究[J].中华肝胆外科杂志, 2007, 13 (9) :585-587.

[6]盛国平, 李兰娟.终末期肝病模型在肝病中的应用进展[J].国际流行病学传染病学杂志, 2006, 33 (1) :68-70.

[7]Huo TL, Wang YW, Yang YY, et al.Model for end-stageliver disease score to serum sodium ratio index as a prognos-tic predictor and its correlation with portal pressure in patientswith liver cirrhosis[J].Liver Int, 2007 (4) , 498-506.

[8]Luca A, Angermayr B, Bertolini G, et al.An integrated MELDmodel including serum sodium and age improves the predictionof early mortality in patients with cirrhosis[J].Liver Transplant, 2007, 13 (8) :1174-1180.

[9]Martin AP, Bartels M, Hauss J, et al.Overview of the MELDscore and the UNOS adult liver allocation system[J].TransplantProc, 2007, 39 (10) :3169-3174.

[10]Cucchetti A, Cucchetti A, Ercolani G, et al.Impact of modelfor end-stage liver disease (MELD) score on prognosis afterhepatectomy for hepatocellular carcinoma on cirrhosis[J].Liver Transplant, 2006, 12 (6) :966-971.

[11]Huo TI, Lee PC, Huang YH, et al.The sequential changesof the model for end-stage liver disease score correlatewith the severity of liver cirrhosis in patients with hepatocel-lular carcinoma undergoing locoregional therapy[J].J ClinGastroenterol, 2006, 40 (5) :543-550.

[12]Huo TI, Lin HC, Wu JC, et al.Limitation of the model forend-stage liver disease for outcome prediction in patientswith cirrhosis-related complications[J].Clin Transplant, 2006, 20 (2) :188-194.

[13]Gotthard TD, Weiss KH, Baumgartner M, et al.Limitationsof the MELD score in predicting mortality or need for removalfrom waiting list in patients awaiting liver transplantation[J].BMC Gastroenterol, 2009, 9 (72) :1-7.

[14]严德辉, 雷俊阳, 陶涛, 等.Child-Pugh分级、终末期肝病模型与肝硬化患者术后并发症的关系[J].肝胆外科杂志[J], 2008, 16 (1) :48-49.

[15]Lalazar G, Adar T, Ilan Y.Point-of-care continuous 13C-methacetin breath test improves decision making in acute liv-er disease:Results of a pilot clinical trial[J].World J Gas-troenterol, 2009, 15 (8) :966-972.

[16]Lalazar G, Pappo O, Hershcovici T, et al.A continuous 13Cmethacetin breath test for noninvasive assessment of intra-hepatic inflammation and fibrosis in patients with chronic HCVinfection and normal ALT[J].J Viral Hepat, 2008, 15 (8) :716-728.

[17]Wutzke K, Forberger A, Wigger M.Effect of alcohol consump-tion on the liver detoxication capacity as measured by[13C]methacetin-and[methyl-13C]methionine-breath tests[J].Isotopes Environ Health Stud, 2008, 44 (2) :219-226.

[18]Lalazar G, Braun M, Ben Ari Z, et al.The non-invasive13C-methacetin breath test accurately detects liver fibrosis inpatients with chronic HCV infection or non-alcoholic fatty liv-er disease[J].J Hepatol, 2007, 46 (S209) .

[19]Dinesen L, Caspary W, Chapman R, et al.13C-methacetin-breath test compared to also noninvasive biochemicalblood tests in predicting hepatic fibrosis and cirrhosis in chro-nic hepatitis C[J].Dig Liver Dis, 2008, 40 (9) :743-748.

[20]Goetze O, Selzner N, Fruehauf H, et al.13C-methacetinbreath test as a quantitative liver function test in patients withchronic hepatitis C infection:continuous automatic molecularcorrelation spectroscopy compared to isotopic ratio mass spec-trometry[J].Aliment Pharmacol Ther, 2007, 26 (3) :305-311.

[21]林言, 宋震亚, 范燕萍, 等.IRIS13C-美沙西汀汀呼气试验在肝硬化患者中的应用及评价[J].临床肝胆病杂志, 2008, 24 (1) :96-98.

[22]陈燕敏, 李建阳, 任森洋.13C-美沙西汀汀呼气试验对肝硬化患者肝脏储备功能的临床研究[J].浙江实用医学, 2008, 13 (1) :79-81.

[23]王萱, 薛华丹, 刘炜, 等.肝脏体积与各种生理参数及不同肝功能评分间的关系[J].中国医学科学院学报, 2009, 31 (2) :237-241.

[24]Zhou XP, Lu T, Wei YG, et al.Liver volume variation in pa-tients with virus-induced cirrhosis:findings on MDCT[J].AJR Am J Roentgenol, 2007, 189 (3) :W153-W159.

[25]黎一鸣, 李华, 吉鸿, 等.D山梨醇肝清除率联合CT肝体积测量评价病肝储备功能[J].中国普外基础与临床杂志, 2009, 16 (4) :285-289.

施引文献

资源附件(0)

访问统计