Methacetin呼氣測試陽性可預測慢性病毒性肝炎的不佳存活

作者：Megan Brooks  
出處：WebMD醫學新聞

　　November 16, 2009 (麻州波士頓) — 碳13 methacetin呼氣測試(MBT；BreathID，Exalenz Bioscience Ltd公司)可以用來準確預測慢性病毒性肝炎病患的長期存活，作為末期肝病模式(Model for End-Stage Liver Disease，MELD)系統的輔助工具。
　　
　　這是根據發表於美國肝病研究協會(Association for the Study of Liver Diseases，AASLD)第60屆年會、2009肝臟會議全體會員大會中，一個有395名病患的臨床試驗結果。
　　
　　瑞士蘇黎世大學醫院胃腸與肝臟科的Beat Mullhaupt醫師在發表時表示，此一檢查所發現的肝功能不佳，有助於我們對病患進行評估。
　　
　　在這項研究中，395名慢性病毒性肝炎病患在攝取75 mg的methacetin之後進行呼氣測試，有80%的病患MELD分數低於10。研究對象的平均年紀為46歲，大約三分之二為男性，多數有C型肝炎病毒感染，這些病患最多被追蹤兩年。
　　
　　包括年紀和MBT參數的MBT存活分數，被用來預測死亡率。根據研究者指出，MBT存活分數每增加一個對數單位，死亡風險增加32%(風險比：1.32；95%信心區間：1.18- 1.48；P< .0001)。
　　
　　MELD分數低於15且死亡的病患，被定義為處於MBT存活分數風險。這395名病患中，11人在追蹤期間死亡；呼氣測試發現這11人中有9人處於高風險。Mullhaupt醫師等人報告指出，重要的是，這11個死亡案例中有6個人的MELD分數低於15。
　　
　　相反的，MBT存活分數歸類為低風險的病患，雖然MELD分數高達23，但沒有病患死亡。
　　
　　紐約市Mount Sinai醫學中心肝病主任、AASLD理事長Scott L. Friedman醫師表示，本研究中有趣的是，實際上，有些病患被視為相對低的MELD分數，也就是說，我們認為他們有相當穩定的肝功能，然而，當進行這個更敏銳的肝功能檢測時，有些病患實際上的存活是減少的。
　　
　　Friedman醫師向記者表示，本研究的含意是，如果有個新科技被確認有效，將可以區別肝功能保存良好的病患以及有可能發生肝衰竭的高風險病患。
　　
　　他指出，這個技術和其他科技實際上代表著新一代之肝病診斷的努力，可以在還沒發生末期疾病之前就預測哪些人有功能不佳的風險。
　　
　　Mullhaup醫師宣告沒有相關財務關係。Friedman醫師參與Exalenz公司的諮詢委員或擔任回顧小組成員。
　　
　　美國肝病研究協會(AASLD)第60屆年會、2009肝臟會議：摘要 96。發表於2009年11月2日。


Positive Methacetin Breath Test Predicts Poor Survival in Chronic Viral Hepatitis

By Megan Brooks
Medscape Medical News

November 16, 2009 (Boston, Massachusetts) — The 13C methacetin breath test (MBT; BreathID, Exalenz Bioscience Ltd) can be used to accurately predict long-term survival in patients with chronic viral hepatitis and might serve as an adjunctive tool to the Model for End-Stage Liver Disease (MELD) system.

That's according to the results of a 395-patient clinical trial reported during a plenary session here at The Liver Meeting 2009: American Association for the Study of Liver Diseases (AASLD) 60th Annual Meeting.

During his presentation, study investigator Beat Mullhaupt, MD, from the Department of Gastroenterology and Hepatology at University Hospital Zurich in Switzerland, said that "impaired liver function picked up by this test could help us in evaluating our patients."

The 395 patients with chronic viral hepatitis in the study performed the breath test after ingesting 75?mg of methacetin. Eighty percent of patients had a MELD score below 10. The average age of study subjects was 46 years, roughly two thirds were male, and most had hepatitis?C virus infection. Patients were followed for up to 2 years.

An MBT survival score, which includes age and MBT parameters, was used to predict mortality. According to the investigators, with each log unit increase in survival score, the risk for death was increased by 32% (hazard ratio, 1.32; 95% confidence interval, 1.18?- 1.48; P?< .0001).

Patients who died with a MELD score below 15 were correctly identified as being at risk by the MBT survival score. Of the 395 patients, 11 died during follow-up; the breath test identified 9 of the 11 as being at high risk. "Importantly, 6 of the 11 deaths occurred in patients with a MELD score below 15," Dr. Mullhaupt and colleagues report.

Conversely, there were no deaths in patients identified as low risk by the MBT survival score, despite MELD scores as high as 23.

AASLD president Scott L. Friedman, MD, chief of liver diseases at Mount Sinai Medical Center in New York CIty, said: "What's interesting about this study is that there were actually patients who had what would be considered a relatively low MELD score. That is, we would think they had pretty stable liver function and yet, when this more subtle test of liver function was performed, some patients actually?.?.?. ended up having decreased survival."

"The implication of this study," Dr. Friedman told reporters, "is that there is now a technology, if it is validated, that can discriminate between patients who have apparently well-preserved liver functioning and yet have a higher risk of succumbing to liver failure."

"This, along with other technologies, really represents a new generation of effort to diagnose liver disease at earlier stages?.?.?. and predict who is at risk for decompensation without having to wait for more advanced disease," he added.

Dr. Mullhaupt has disclosed no relevant financial relationships. Dr. Friedman has participated in advisory committees or review panels for Exalenz.

The Liver Meeting 2009: American Association for the Study of Liver Diseases (AASLD) 60th Annual Meeting: Abstract 96. Presented November?2, 2009.