Everson G T, Martucci M A, Shiffman M L, Sterling R K, Morgan T R, Hoefs J C
Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Denver, CO, USA.
Aliment Pharmacol Ther. 2007 Aug 1;26(3):401-10. doi: 10.1111/j.1365-2036.2007.03389.x.
Measurement of portal inflow and portal-systemic shunt using cholate clearances could be useful in monitoring patients with liver disease.
To examine relationships of cholate clearances and shunt to cirrhosis and varices and to define minimal sampling requirements.
Five hundred forty-eight studies were performed in 282 patients enrolled in the Hepatitis C Antiviral Long-term Treatment to prevent Cirrhosis (HALT-C) trial. Stable, non-radioactive isotopes of cholate were administered intravenously and orally, clearances (Cl(iv) and Cl(oral)) were calculated from [dose/area under curve (AUC)] and cholate shunt from [(AUC(oral):AUC(iv)) x (Dose(iv):Dose(oral)) x 100%].
Cholate Cl(oral) and cholate shunt correlated with prevalences of both cirrhosis and varices (P < 0.0001 for all). Peripheral venous sampling at 5, 20, 45, 60 and 90 min defined the minimal model. Linear regression of cholate shunt determined from five points within 90 min vs. the standard method of 14 points over 3 h yielded slope of 1.0 and intercept 0.5% (r(2) = 0.98, P < 0.0001). Results were identical in the 189 validation studies (slope 1.0, intercept 0.5%, r(2) = 0.99, P < 0.0001).
Cholate Cl(oral) and cholate shunt may be useful in monitoring patients with liver disease. The 5-point model enhances application of cholate Cl(oral) and cholate shunt in the non-invasive assessment of the portal circulation.
利用胆酸盐清除率测量门静脉血流和门体分流，可能有助于监测肝病患者。
研究胆酸盐清除率及分流与肝硬化和静脉曲张的关系，并确定最小采样要求。
对参加丙型肝炎抗病毒长期治疗预防肝硬化（HALT-C）试验的282例患者进行了548项研究。静脉内和口服给予稳定的、非放射性的胆酸盐同位素，根据[剂量/曲线下面积（AUC）]计算清除率（Cl(iv)和Cl(口服)），并根据[(AUC(口服):AUC(iv))×(剂量(iv):剂量(口服))×100%]计算胆酸盐分流。
胆酸盐Cl(口服)和胆酸盐分流与肝硬化和静脉曲张的患病率均相关（所有P<0.0001）。在5、20、45、60和90分钟进行外周静脉采样确定了最小模型。90分钟内5个点测定的胆酸盐分流与3小时内14个点的标准方法进行线性回归，斜率为1.0，截距为0.5%（r(2)=0.98，P<0.0001）。189项验证研究结果相同（斜率1.0，截距0.5%，r(2)=0.99，P<0.0001）。
胆酸盐Cl(口服)和胆酸盐分流可能有助于监测肝病患者。5点模型增强了胆酸盐Cl(口服)和胆酸盐分流在门静脉循环无创评估中的应用。
