【摘要】 目的:探讨基于红外线同位素能谱分析仪的¹³C-嘧噻西啶呼气试验(¹³C-MBT)对非酒精性脂肪肝病（NAFLD）患者肝功能储备的无创评估价值。方法:前瞻性选取2023年1月至2024年1月在新疆医科大学第一附属医院肝病科就诊的120例符合诊断标准的NAFLD患者,根据肝脏瞬时弹性成像（FibroTouch）检测的肝脏硬度测量值（LSM）将其分为轻度纤维化组（LSM<7.0kPa,40例）、中度纤维化组（7.0≤LSM<9.5kPa,40例）和重度纤维化组（LSM≥9.5kPa,40例）;同时选取40例健康体检者作为健康对照组。所有受试者均接受¹³C-MBT和常规肝功能检测,比较各组间的¹³C-MBT的参数和肝功能指标的差异,并分析¹³C-MBT的参数与肝功能指标和肝纤维化程度的相关性。采用受试者工作特征（ROC）曲线分析评价¹³C-MBT的参数对肝纤维化程度的判断效能。结果:NAFLD患者的¹³C-MBT的40min最大代谢速率峰值(MV_max40)、40min和120min代谢速率累计值(CUM₄₀和CUM₁₂₀)均低于健康对照组,差异有统计学意义（F=27.413、28.635、29.851,P<0.05）。随着肝纤维化程度的加重,NAFLD患者的¹³C-MBT参数逐渐降低,重度纤维化组的¹³C-MBT的参数均低于轻度纤维化组和中度纤维化组,差异有统计学意义（t=12.331、13.020、14.232、22.033、21.032、29.332,P<0.05）。¹³C-MBT参数与肝功能指标呈正相关,与LSM呈负相关,相关系数的绝对值均>0.5,差异均有统计学意义（r=0.375～0.875,P<0.05）。¹³C-MBT参数对肝纤维化程度的判断具有较高的敏感性和特异性,以MV_max40为例,当以9.5 kPa为界限值时,其灵敏度为86.3%,特异度为83.8%,准确率为85.0%,ROC曲线下面积（AUC）为0.913。结论:基于红外线同位素能谱分析仪的¹³C-MBT是一种无创、安全、快速、准确的检测方法,能够反映NAFLD患者的肝功能储备和肝纤维化程度,对NAFLD的诊断和治疗具有重要的临床价值。更多还原

【Abstract】 Objective:To evaluate the value of noninvasive assessment of the ¹³C-methacetin breath test(¹³C-MBT) based on infrared isotope spectrometry for liver function reserve in patients with nonalcoholic fatty liver disease（NAFLD）.Methods:A total of 120 NAFLD patients met the diagnostic criteria,who admitted to Department of Liver Diseases of the First Affiliated Hospital of Xinjiang Medical University from January 2023 to January 2024,were prospectively selected.Patients were divided into three groups based on liver stiffness measurement（LSM） of FibroTouch:mild fibrosis group（LSM<7.0 kPa,n=40）,moderate fibrosis group（7.0≤LSM<9.5 kPa） and severe fibrosis group（LSM≥9.5 kPa,n=40）.Meanwhile,40 healthy subjects were selected as a healthy control group.All subjects underwent ¹³C-MBT and conventional liver function tests.The differences of ¹³C-MBT parameters and liver function indicators among various groups were compared,and the correlations between ¹³C-MBT parameters and the degree of liver fibrosis,and between liver function indexes and the degree of liver fibrosis were analyzed.Receiver operating characteristic（ROC） curve was used to evaluate the judgment ability of ¹³C-MBT parameters to the degree of liver fibrosis.Results:The ¹³C-MBT parameters in NAFLD patients were lower than those in healthy control group,and the differences were statistically significant（F=27.413,28.635,29.851,P<0.05）.With the aggravation of liver fibrosis,¹³C-MBT parameters in NAFLD patients gradually decreased.The ¹³C-MBT parameters of severe fibrosis group were significantly lower than those in the mild and moderate fibrosis groups,with statistically significant differences（t=12.331,13.020,14.232,22.033,21.032,29.332,P<0.05）,respectively.The ¹³C-MBT parameters were positively correlated with liver function indicators,and were negatively correlated with LSM,and the absolute values of the correlation coefficients were> 0.5,all of them showed statistically significant differences（r=0.375,-0.875,P<0.05）.The ¹³C-MBT parameters had higher sensitivity and specificity in judging the degree of liver fibrosis.Taking MV_max40 as an example,when the limit value was 9.5 kPa,the sensitivity was 86.3%,and the specificity was 83.8%,and the accuracy was 85.0%,and the area under curve（AUC） was 0.913.Conclusion:¹³C-MBT based on infrared isotope spectrometry is a non-invasive,safe,rapid and accurate detection method,which can reflect the liver function reserve and liver fibrosis degree of NAFLD patients,and has important clinical value for the diagnosis and treatment of NAFLD.更多还原