L-1-~(13)C-苯丙氨酸呼气试验在慢性肝病临床分期中的应用

Clinical Practice of L-1-~(13)C-phenylalanine in Staging of Chronic Liver Disease

  • 摘要: 用L-1-13C-苯丙氨酸对12例正常对照、8例慢性乙型肝炎G2S2期患者、12例肝硬化代偿期患者、12例肝硬化失代偿期患者进行6 h呼气试验,共采集气样24次,用气体同位素比值质谱仪检测气样中13CO2浓度,试验参数选用30min13C排除速率13CER30、60min累计13C排除率13Ccum60、13CO2半排除时间T1/2。结果显示,所有受试者13C排除均呈单峰;T1/2在正常人、慢性肝炎患者、肝硬化代偿和失代偿患者之间差异有显著性(P<0.05),而13CER30、13Ccum60仅在正常人肝硬化代偿和失代偿患者之间差异有显著性(P<0.05);13CER30、13Ccum60、T1/2与除丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)外的部分临床常规肝功能血清学检查值存在不同程度的相关性。提示L-1-13C-苯丙氨酸呼气试验是一项安全、简便、定量、有效的肝功能检测手段,可用于慢性肝病的临床分期。

     

    Abstract: Twelve healthy controls, eight patients with chronic hepatitis graded G2S2,twelve patients with compensated liver cirrhosis, twelve patients with decompensated liver cirrhosis are studied by L-1-13C-phenylalanine breath test which is longed for 6 hours and 24 breath samples per subject are collected. 13CO2 enrichment are measured by isotope ratio mass spectrometer. The results show that 13CO2 half excretion time T1/2 can significantly differentiate the four groups(P<0.05), however the 13CER30 and 13Ccum6o can differentiate normal subjects, patients with compensated liver cirrhosis and decompensated liver cirrhosis, but the discrepancy of the them are not significant between patients with chronic hepatitis and healthy controls or patients with compensated (P>0.05). The three parameters are significantly correlated with some standard clinical serum-biochemical datum(P<0. 05), but not the level of serum alanine transaminase(AL)and aspartate transaminase(AST). So,L-1-13C-phenylalanine breath test may be a promising clinical tool to grade chronic liver disease, which is safe, simple, quantificational and effective.

     

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