Malinowski Maciej, Jara Maximilian, Lüttgert Katja, Orr James, Lock Johan Friso, Schott Eckart, Stockmann Martin
Department of General, Visceral and Transplantation Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany,
Dig Dis Sci. 2014 Dec;59(12):2983-91. doi: 10.1007/s10620-014-3250-z. Epub 2014 Jul 4.
Assessment and quantification of actual liver function is crucial in patients with chronic liver disease to monitor disease progression and predict individual prognosis. Mathematical models, such as model for end-stage liver disease, are used for risk stratification of patients with chronic liver disease but do not include parameters that reflect the actual functional state of the liver.
We aimed to evaluate the potential of a (13)C-based liver function test as a stratification tool by comparison with other liver function tests and clinical parameters in a large sample of healthy controls and cirrhotic patients.
We applied maximum liver function capacity (LiMAx) to evaluate actual liver function in 347 patients with cirrhosis and in 86 controls.
LiMAx showed strong negative correlation with Child-Pugh Score (r = -0.707; p < 0.001), MELD (r = -0.686; p < 0.001) and liver function tests. LiMAx was lower in patients with liver cirrhosis compared to healthy controls [99 (57-160) µg/kg/h vs. 412 (365-479) µg/kg/h, p < 0.001] and differed among Child-Pugh classes [a: 181 (144-227) µg/kg/h, b: 96 (62-132) µg/kg/h and c: 52 (37-81) µg/kg/h; p < 0.001]. When stratified patients according to disease severity, LiMAx results were not different between cirrhotic patients and cirrhotic patients with transjugular intrahepatic portosystemic shunt.
LiMAx appears to provide reliable information on remnant enzymatic liver function in chronic liver disease and allows graduation of disease severity.
评估和量化实际肝功能对于慢性肝病患者监测疾病进展和预测个体预后至关重要。数学模型，如终末期肝病模型，用于慢性肝病患者的风险分层，但不包括反映肝脏实际功能状态的参数。
我们旨在通过与大量健康对照者和肝硬化患者的其他肝功能检查及临床参数进行比较，评估基于¹³C的肝功能检查作为分层工具的潜力。
我们应用最大肝功能容量（LiMAx）评估347例肝硬化患者和86例对照者的实际肝功能。
LiMAx与Child-Pugh评分（r = -0.707；p < 0.001）、终末期肝病模型（MELD）评分（r = -0.686；p < 0.001）及肝功能检查呈强负相关。与健康对照者相比，肝硬化患者的LiMAx较低[99（57 - 160）μg/kg/h vs. 412（365 - 479）μg/kg/h，p < 0.001]，且在Child-Pugh分级之间存在差异[a级：181（144 - 227）μg/kg/h，b级：96（62 - 132）μg/kg/h，c级：52（37 - 81）μg/kg/h；p < 0.001]。根据疾病严重程度对患者进行分层时，肝硬化患者与经颈静脉肝内门体分流术的肝硬化患者之间的LiMAx结果无差异。
LiMAx似乎能提供有关慢性肝病残余肝脏酶功能的可靠信息，并能对疾病严重程度进行分级。
