13C标记的混合甘油三酯呼气试验在评估胰腺手术后胰腺外分泌功能中的应用价值。

Usefulness of a 13C-labeled mixed triglyceride breath test for assessing pancreatic exocrine function after pancreatic surgery.

作者信息

Nakamura Hiroyuki, Morifuji Masahiko, Murakami Yoshiaki, Uemura Kenichiro, Ohge Hiroki, Hayashidani Yasuo, Sudo Takeshi, Sueda Taijiro

机构信息

Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

出版信息

Surgery. 2009 Feb;145(2):168-75. doi: 10.1016/j.surg.2008.08.013. Epub 2008 Sep 25.

DOI:10.1016/j.surg.2008.08.013

PMID:19167971

Abstract

BACKGROUND

Although the fecal elastase-1 test is a satisfactory pancreatic exocrine function test, breath tests that use stable isotopes have been developed recently as alternatives. We evaluated the usefulness of a (13)C-labeled mixed triglyceride breath test for assessing pancreatic exocrine function after pancreatic surgery.

METHODS

The breath test and the fecal elastase-1 test were performed on 7 healthy volunteers, 10 patients with chronic pancreatitis, and 95 patients after pancreatic surgery. The breath test was analyzed with isotope ratio mass spectrometry and the cumulative recovery of (13)CO(2) at 7 hours (% dose (13)C cum 7h) was calculated. The fecal elastase-1 concentration was determined immunoenzymatically.

RESULTS

Both the fecal elastase-1 concentration and the % dose (13)C cum 7h of chronic pancreatitis patients and pancreatic resection patients were less than those of healthy volunteers. In all subjects, % dose (13)C cum 7h correlated with the fecal elastase-1 concentration (n = 112, R(2) = 0.14, P < .01). Accuracy rates for clinical symptoms, including clinical steatorrhea, for the fecal test and the breath test were 62 and 88%, respectively.

CONCLUSION

The (13)C-labeled mixed triglyceride breath test might be more useful than the fecal elastase-1 test for evaluating pancreatic exocrine function after pancreatic resection.

摘要

背景

尽管粪便弹性蛋白酶-1检测是一项令人满意的胰腺外分泌功能检测，但近年来已开发出使用稳定同位素的呼气试验作为替代方法。我们评估了（13）C标记的混合甘油三酯呼气试验在评估胰腺手术后胰腺外分泌功能方面的实用性。

方法

对7名健康志愿者、10名慢性胰腺炎患者和95名胰腺手术后患者进行了呼气试验和粪便弹性蛋白酶-1检测。呼气试验采用同位素比率质谱法进行分析，并计算7小时时（13）CO2的累积回收率（%剂量（13）C累积7小时）。粪便弹性蛋白酶-1浓度采用免疫酶法测定。

结果

慢性胰腺炎患者和胰腺切除患者的粪便弹性蛋白酶-1浓度和%剂量（13）C累积7小时均低于健康志愿者。在所有受试者中，%剂量（13）C累积7小时与粪便弹性蛋白酶-1浓度相关（n = 112，R2 = 0.14，P <.01）。粪便检测和呼气试验对包括临床脂肪泻在内的临床症状的准确率分别为62%和88%。