D'Arienzo A, Celentano L, Cimino L, Panarese A, Lancia C, Vergara E, Castaldo G, Oriani G, Squame G, Budillon G
I Cattedra di Gastroenterologia, University of Naples Federico II, Italy.
J Hepatol. 1992 Mar;14(2-3):188-93. doi: 10.1016/0168-8278(92)90157-k.
We evaluated the role of per-rectal portal scintigraphy with 99m-technetium pertechnetate (99m-Tc test) for early diagnosis of cirrhosis. Forty patients with biochemical evidence of chronic liver disease were studied. Laparobiopsy documented chronic active hepatitis (CAH) without cirrhosis in 22 of the patients and CAH with cirrhosis (CAHc) in 18 patients. Clinical or laboratory findings could not differentiate between CAH and CAHc. Twelve healthy volunteers served as controls. The results, expressed as shunt index (SI), i.e., the ratio between heart radioactivity and the sum of heart and liver radioactivity in the first 30 s of observation, were: controls 5.66 +/- 1.66, CAH 15.27 +/- 2.83 and CAHc 24.88 +/- 3.95. A significant difference between the mean SI values in the three groups studied (F = 142.71, p less than 0.0001) was observed. At values less than 17, our test showed a predictivity of 100% for cirrhosis exclusion, while at values higher than 19 the predictive positive value for a diagnosis of cirrhosis was 100%. Invasive diagnostic procedures should be performed only in patients with SI values between 17-19.
我们评估了用高锝酸盐（99m-Tc试验）进行直肠门静脉闪烁扫描在肝硬化早期诊断中的作用。对40例有慢性肝病生化证据的患者进行了研究。腹腔镜活检显示，22例患者为无肝硬化的慢性活动性肝炎（CAH），18例患者为伴有肝硬化的慢性活动性肝炎（CAHc）。临床或实验室检查结果无法区分CAH和CAHc。12名健康志愿者作为对照。结果以分流指数（SI）表示，即观察前30秒内心脏放射性与心脏和肝脏放射性总和之比，结果如下：对照组5.66±1.66，CAH组15.27±2.83，CAHc组24.88±3.95。观察到研究的三组平均SI值之间存在显著差异（F = 142.71，p < 0.0001）。当SI值小于17时，我们的试验显示排除肝硬化的预测性为100%，而当SI值高于19时，诊断肝硬化的预测阳性值为100%。仅应对SI值在17至19之间的患者进行侵入性诊断程序。
