肝功能的无创评估。
Noninvasive assessment of liver function.
作者信息
Helmke Steve, Colmenero Jordi, Everson Gregory T
机构信息
aUniversity of Colorado Denver School of Medicine, Aurora, Colorado, USA bLiver Unit, Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain.
出版信息
Curr Opin Gastroenterol. 2015 May;31(3):199-208. doi: 10.1097/MOG.0000000000000167.
PURPOSE OF REVIEW
It is our opinion that there is an unmet need in hepatology for a minimally or noninvasive test of liver function and physiology. Quantitative liver function tests define the severity and prognosis of liver disease by measuring the clearance of substrates whose uptake or metabolism is dependent upon liver perfusion or hepatocyte function. Substrates with high-affinity hepatic transporters exhibit high 'first-pass' hepatic extraction and their clearance measures hepatic perfusion. In contrast, substrates metabolized by the liver have low first-pass extraction and their clearance measures specific drug metabolizing pathways.
RECENT FINDINGS
We highlight one quantitative liver function test, the dual cholate test, and introduce the concept of a disease severity index linked to clinical outcome that quantifies the simultaneous processes of hepatocyte uptake, clearance from the systemic circulation, clearance from the portal circulation, and portal-systemic shunting.
SUMMARY
It is our opinion that dual cholate is a relevant test for defining disease severity, monitoring the natural course of disease progression, and quantifying the response to therapy.
综述目的
我们认为，肝病学领域迫切需要一种微创或无创的肝功能及生理功能检测方法。定量肝功能检测通过测量其摄取或代谢依赖于肝脏灌注或肝细胞功能的底物的清除率，来确定肝病的严重程度和预后。具有高亲和力肝脏转运体的底物表现出高“首过”肝脏摄取率，其清除率可衡量肝脏灌注。相比之下，经肝脏代谢的底物首过摄取率较低，其清除率可衡量特定的药物代谢途径。
最新发现
我们重点介绍一种定量肝功能检测方法——双胆酸盐检测，并引入与临床结局相关的疾病严重程度指数的概念，该指数可量化肝细胞摄取、从体循环清除、从门静脉循环清除以及门体分流的同步过程。
总结
我们认为双胆酸盐检测对于定义疾病严重程度、监测疾病进展的自然过程以及量化治疗反应是一种相关检测方法。
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