D'Arienzo A, Celentano L, Scuotto A, Di Siervi P, Lombardi V, Squame G, Mazzacca G
Cattedra di Malattia dell'Apparato Digerente, Second Faculty of Medicine, University of Naples, Italy.
Hepatology. 1988 Jul-Aug;8(4):785-7. doi: 10.1002/hep.1840080415.
In normal subjects, thallium-201, administered per rectum, is taken up mainly by the liver (heart/liver ratio in normal subjects: 0.04 to 0.12). It has been claimed that an increased heart/liver ratio is suggestive of portal-caval shunting and portal hypertension. To evaluate the possibility of using thallium-201 as a test to diagnose cirrhosis, we administered this substance per rectum to 33 patients with biochemical evidence, but no clinical symptoms, of liver disease. Laparoscopy and liver biopsy revealed chronic active hepatitis without cirrhosis in 18 patients, and chronic active hepatitis with cirrhosis in the others. The results of conventional liver function tests were similar in both groups. A significant difference, however, was found between the means of fasting serum bile acid concentrations (9.8 +/- 3.2 and 18.3 +/- 4.2 microM per liter) in chronic active hepatitis without cirrhosis and cirrhotic patients, and between the means of the heart/liver ratios 20 min after thallium-201 administration (heart/liver: 0.09 +/- 0.03 and 0.54 +/- 0.13, respectively). Unlike the serum bile acid concentration which gave some overlapping values, the thallium-201 test clearly distinguished the chronic active hepatitis without cirrhosis group from the cirrhotics. In the cirrhotic group, there was a significant correlation between the heart/liver ratio and signs of portal hypertension such as esophageal varices, increased diameter of the vena porta and hypersplenism. The thallium-201 test is therefore useful in discriminating between chronic active hepatitis with and without cirrhosis in clinically asymptomatic subjects with biochemical evidence of moderate liver function impairment. A heart/liver uptake ratio much higher than normal (above 0.30) strongly suggests the development of hepatic cirrhosis.
在正常受试者中，经直肠给予的铊-201主要被肝脏摄取（正常受试者的心脏/肝脏摄取率为0.04至0.12）。据称，心脏/肝脏摄取率升高提示门静脉-腔静脉分流和门静脉高压。为了评估使用铊-201作为诊断肝硬化的试验的可能性，我们对33例有肝病生化证据但无临床症状的患者经直肠给予了这种物质。腹腔镜检查和肝活检显示，18例患者为无肝硬化的慢性活动性肝炎，其余患者为有肝硬化的慢性活动性肝炎。两组的常规肝功能检查结果相似。然而，在无肝硬化的慢性活动性肝炎患者和肝硬化患者中，空腹血清胆汁酸浓度平均值（分别为9.8±3.2和18.3±4.2微摩尔/升）之间以及给予铊-201后20分钟时的心脏/肝脏摄取率平均值（心脏/肝脏摄取率分别为0.09±0.03和0.54±0.13）之间存在显著差异。与血清胆汁酸浓度有一些重叠值不同，铊-201试验清楚地区分了无肝硬化的慢性活动性肝炎组和肝硬化患者组。在肝硬化组中，心脏/肝脏摄取率与门静脉高压体征如食管静脉曲张、门静脉直径增加和脾功能亢进之间存在显著相关性。因此，铊-201试验有助于在有中度肝功能损害生化证据的临床无症状受试者中鉴别有无肝硬化的慢性活动性肝炎。心脏/肝脏摄取率远高于正常水平（高于0.30）强烈提示肝硬化的发生。
