用于评估胰腺外分泌功能不全的13C标记辛酸胆固醇呼气试验

13C labelled cholesteryl octanoate breath test for assessing pancreatic exocrine insufficiency.

作者信息

Ventrucci M, Cipolla A, Ubalducci G M, Roda A, Roda E

机构信息

Department of Internal Medicine and Gastroenterology, Sant'Orsola Hospital, University of Bologna, Italy.

出版信息

Gut. 1998 Jan;42(1):81-7. doi: 10.1136/gut.42.1.81.

DOI:10.1136/gut.42.1.81

PMID:9505890

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1726942/

Abstract

BACKGROUND

A non-invasive test for assessment of fat digestion has been developed based on the intraluminal hydrolysis of cholesteryl-[1-13C]octanoate by pancreatic esterase.

AIMS

To determine the diagnostic performance of this breath test in the assessment of exocrine pancreatic function.

METHODS

The test was performed in 20 healthy controls, 22 patients with chronic pancreatic disease (CPD), four with biliopancreatic diversion (BPD), and 32 with non-pancreatic digestive diseases (NPD); results were compared with those of other tubeless tests (faecal chymotrypsin and fluorescein dilaurate test).

RESULTS

Hourly recoveries of 13CO2 were significantly lower in CPD when compared with healthy controls or NPD. In patients with CPD with mild to moderate insufficiency, the curve of 13CO2 recovery was similar to that of healthy controls, while in those with severe insufficiency it was flat. In three patients with CPD with severe steatorrhoea, a repeat test after pancreatic enzyme supplementation showed a significant rise in 13CO2 recovery. The four BPD patients had low and delayed 13CO2 recovery. Only eight of the 32 patients with NPD had abnormal breath test results. There was a significant correlation between the results of the breath test and those of faecal chymotrypsin, the fluorescein dilaurate test, and faecal fat measurements. For the diagnosis of pancreatic disease using the three hour cumulative 13CO2 recovery test, the sensitivity was 68.2% and specificity 75.0%; values were similar to those of the other two tubeless pancreatic function tests. In seven healthy controls, nine patients with CPD, and nine with NPD a second breath test was performed using Na-[1-13C]octanoate and a pancreatic function index was calculated as the ratio of 13C recovery obtained in the two tests: at three hours this index was abnormal in eight patients with CPD and in three with NPD.

CONCLUSION

The cholesteryl-1[1-13C]octanoate breath test can be useful for the diagnosis of fat malabsorption and exocrine pancreatic insufficiency.

摘要

背景

基于胰酯酶对胆固醇基-[1-¹³C]辛酸酯的腔内水解作用，已开发出一种用于评估脂肪消化的非侵入性检测方法。

目的

确定该呼气试验在评估胰腺外分泌功能中的诊断性能。

方法

对20名健康对照者、22例慢性胰腺疾病（CPD）患者、4例胆胰转流术（BPD）患者和32例非胰腺消化系统疾病（NPD）患者进行了该检测；将结果与其他无管检测方法（粪便糜蛋白酶和荧光素二月桂酸酯检测）的结果进行比较。

结果

与健康对照者或NPD患者相比，CPD患者¹³CO₂的每小时回收率显著降低。在轻度至中度胰腺功能不全的CPD患者中，¹³CO₂回收率曲线与健康对照者相似，而在重度胰腺功能不全的患者中则呈平坦状。在3例重度脂肪泻的CPD患者中，补充胰酶后重复检测显示¹³CO₂回收率显著升高。4例BPD患者¹³CO₂回收率低且延迟。32例NPD患者中只有8例呼气试验结果异常。呼气试验结果与粪便糜蛋白酶、荧光素二月桂酸酯检测和粪便脂肪测量结果之间存在显著相关性。使用三小时累积¹³CO₂回收率检测诊断胰腺疾病时，敏感性为68.2%，特异性为75.0%；这些值与其他两种无管胰腺功能检测方法的值相似。对7名健康对照者、9例CPD患者和9例NPD患者进行了第二次呼气试验，使用钠-[1-¹³C]辛酸酯，并计算胰腺功能指数，即两次检测中¹³C回收率的比值：在三小时时，该指数在8例CPD患者和3例NPD患者中异常。