Grieco A, Castellano R, Matera A, Marcoccia S, Di Rocco P, Ragazzoni E, Vecchio F M, Gasbarrini G
Department of Internal Medicine and Geriatrics, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
J Gastroenterol Hepatol. 1998 May;13(5):460-6. doi: 10.1111/j.1440-1746.1998.tb00668.x.
Antipyrine metabolism is widely used as an index of the drug-metabolizing reserve of the liver. It is well known that metabolism of this drug is impaired in subjects with acute hepatitis or cirrhosis, but conflicting data have been reported regarding patients with chronic postinfectious hepatitis or liver cancer. We studied conventional liver-function parameters and antipyrine metabolism (antipyrine per o.s. 18 mg/kg) in 518 subjects. One hundred and one patients had liver metastases (various primaries). Based on the number and size of lesions, the hepatic involvement was considered minimal in 47 and massive in 54 (groups B1 and B2, respectively). One hundred and two had chronic active hepatitis (CAH); 51 patients with histological evidence of fibrosis/early cirrhosis and 51 patients were without histological evidence of fibrosis/early cirrhosis. Ninety-two had histologically confirmed cirrhosis (group D), and the remaining 120 had cirrhosis and hepatocellular carcinoma (group E). The control group was composed of 103 subjects with healthy livers (group A). Antipyrine clearance (AP Cl) in CAH patients with fibrosis (0.246 +/- 0.98 mL/min per kg) was similar to that observed in patients with cirrhosis (0.223 +/- 0.148 mL/min per kg), and both values were significantly lower than that found in CAH patients without fibrosis (0.406 +/- 0.159 mL/min per kg, P < 0.01). Antipyrine clearance in patients with liver metastases (0.426 +/- 0.174 mL/min per kg) was similar to that of the healthy group (0.489 +/- 0.210 mL/min per kg). Cirrhotics and cirrhotics with hepatocellular carcinoma (HCC) presented similar degrees of impairment. Antipyrine clearance was positively correlated with serum albumin (r2 = 0.10, P = 0.01) and prothrombin time (r2 = 0.129, P < 0.01) in all groups, except those with liver metastases. In patients with CAH, the presence of fibrosis/cirrhosis is associated with impaired antipyrine metabolism. The lack of impairment in groups with liver metastases suggests that the functional hepatic reserve is maintained even in the presence of massive neoplastic invasion.
安替比林代谢被广泛用作肝脏药物代谢储备的指标。众所周知，急性肝炎或肝硬化患者的这种药物代谢受损，但关于慢性感染后肝炎或肝癌患者的数据却相互矛盾。我们研究了518名受试者的传统肝功能参数和安替比林代谢（口服安替比林18mg/kg）。101例患者有肝转移（原发肿瘤各异）。根据病变的数量和大小，47例患者的肝脏受累被认为是轻度的，54例患者的肝脏受累被认为是重度的（分别为B1组和B2组）。102例患者患有慢性活动性肝炎（CAH）；51例有纤维化/早期肝硬化组织学证据的患者和51例无纤维化/早期肝硬化组织学证据的患者。92例有组织学证实的肝硬化（D组），其余120例有肝硬化和肝细胞癌（E组）。对照组由103例肝脏健康的受试者组成（A组）。有纤维化的CAH患者的安替比林清除率（AP Cl）（0.246±0.98mL/min per kg）与肝硬化患者的相似（0.223±0.148mL/min per kg），且这两个值均显著低于无纤维化的CAH患者（0.406±0.159mL/min per kg，P<0.01）。肝转移患者的安替比林清除率（0.426±0.174mL/min per kg）与健康组相似（0.489±0.210mL/min per kg）。肝硬化患者和伴有肝细胞癌（HCC）的肝硬化患者表现出相似程度的损害。除肝转移患者外，所有组的安替比林清除率与血清白蛋白呈正相关（r2=0.10，P=0.01），与凝血酶原时间呈正相关（r2=0.129，P<0.01）。在CAH患者中，纤维化/肝硬化的存在与安替比林代谢受损有关。肝转移组未出现损害表明，即使存在大量肿瘤浸润，肝脏功能储备仍得以维持。
