Li Hong-xia, Wang Jun-ping, Yang Ying, Zhang Jin, Feng Qiu-ling
Department of Gastroenterology, Shanxi Province People's Hospital, Taiyuan 030012, China.
Zhonghua Nei Ke Za Zhi. 2009 May;48(5):383-7.
To investigate the characteristic of 13C-methacetin breath test (13C-MBT) as a tool to monitor the hepatic function of patients with hepatic carcinoma by comparing with Child-Pugh classification and general liver function.
Thirty-nine patients with primary liver cancer, 16 patients with hepatic metastasis and 14 healthy volunteers serving as controls were included in this study. According to Child-Pugh classification, the primary liver cancer patients were divided into A, B and C subgroups. All subjects received 13C-MBT and routine liver function tests after an overnight fast. The three major parameters of 13C-MBT i.e. maximum excretion rate before 40 min (Mvmax40), 13CO2 cumulative excretion of 40 min (CUM40) and that of 120 min (CUM120) were recorded and the two metabolism curves (DOB curve, MV curve) were made.
(1) In the control, hepatic metastasis and primary liver cancer groups, both the DOB curve and MV curve were similar in shape; the peak time occurred at about 20 min after administration and then the curves lowered progressively. There were significant differences between the primary liver cancer group and the other two groups, but it was not statistically different between the hepatic metastasis group and the controls. The shape was obviously distinct in the groups A, B and C of primary liver cancer. The group A had a single sharp peak curve, group B a relatively flat peak curve with a lower level for a long time after the ascending phase and group C no clear excretion peak or even a negative curve. (2) As to the three parameters of 13C-MBT, there were statistical difference between the primary liver cancer group and the other two groups (P<0.05). Between hepatic metastasis group and controls, there was statistical difference about CUM120 (P<0.05), but no statistical difference about Mvmax40 and CUM40. While in the three groups with primary liver cancer groups, there was statistical difference between group A and B in Mvmax40 and CUM40 (P<0.05), but no statistical difference between group B and C. As to CUM120, there was statistical difference only between group A and C. (3) Comparing the three parameters of 13C-MBT with routine liver function tests, there was negative correlation with TBA, positive correlation with Alb, PA, ChE and no correlation with ALT, AST, TBil, gamma-GT, ALP and PT. (4) There was a good consistency between 13C-MBT and Child-Pugh classification in the evaluation of liver function of patients with liver cancer (Kappa=0.647, P<0.05).
The value of the three parameters of 13C-MBT is decreased with severity of the liver disease and 13C-MBT may be used to evaluate the reserved hepatic function in patients with primary liver cancer with a diagnostic value equivalent to Child-Pugh classification. The study further confirms that 13C-MBT has correlation with TBA, Alb, PA and ChE.
通过与Child-Pugh分级及常规肝功能指标比较，探讨13C-美沙西汀呼气试验（13C-MBT）作为监测肝癌患者肝功能的工具的特点。
本研究纳入39例原发性肝癌患者、16例肝转移患者及14名健康志愿者作为对照。根据Child-Pugh分级，将原发性肝癌患者分为A、B、C亚组。所有受试者在禁食过夜后接受13C-MBT及常规肝功能检查。记录13C-MBT的三个主要参数，即40分钟前的最大排泄率（Mvmax40）、40分钟的13CO2累积排泄量（CUM40）及120分钟的13CO2累积排泄量（CUM120），并绘制两条代谢曲线（DOB曲线、MV曲线）。
（1）在对照组、肝转移组和原发性肝癌组中，DOB曲线和MV曲线形状相似；给药后约20分钟出现峰值，随后曲线逐渐下降。原发性肝癌组与其他两组之间存在显著差异，但肝转移组与对照组之间无统计学差异。原发性肝癌A、B、C组的曲线形状明显不同。A组为单一尖峰曲线，B组为相对平坦的峰值曲线，上升期后长时间处于较低水平，C组无明显排泄峰甚至为负曲线。（2）对于13C-MBT的三个参数，原发性肝癌组与其他两组之间存在统计学差异（P<0.05）。肝转移组与对照组之间，CUM120存在统计学差异（P<0.05），但Mvmax40和CUM40无统计学差异。在原发性肝癌的三组中，A组和B组在Mvmax40和CUM40方面存在统计学差异（P<0.05），但B组和C组之间无统计学差异。对于CUM120，仅A组和C组之间存在统计学差异。（3）将13C-MBT的三个参数与常规肝功能检查进行比较，与TBA呈负相关，与Alb、PA、ChE呈正相关，与ALT、AST、TBil、γ-GT、ALP和PT无相关性。（4）在评估肝癌患者肝功能方面，13C-MBT与Child-Pugh分级具有良好的一致性（Kappa=0.647，P<0.05）。
13C-MBT三个参数的值随肝病严重程度降低，13C-MBT可用于评估原发性肝癌患者的残余肝功能，其诊断价值与Child-Pugh分级相当。该研究进一步证实13C-MBT与TBA、Alb、PA和ChE相关。
