特集名 | 機能性消化器疾患へのアプローチ -- 病態理解から的確な診療へ | |
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題名 | 膵外分泌機能検査 -- 13C 呼気試験によるアプローチ | |
発刊年月 | 2009年 11月 | |
著者 | 松本 敦史 | 弘前大学医学部内分泌・代謝内科 |
著者 | 丹藤 雄介 | 弘前大学医学部内分泌・代謝内科 |
著者 | 柳町 幸 | 弘前大学医学部内分泌・代謝内科 |
著者 | 中村 光男 | 弘前大学医学部保健学科病因病態検査学 |
【 要旨 】 | 本邦では膵性脂肪便(食事による脂肪摂取量が40g/day 以上で糞便中脂肪排泄量5g/day 以上)を呈する場合を膵外分泌機能不全と定義している.膵外分泌機能不全を認める場合には膵消化酵素補充療法の適応となる.しかし蓄便による診断・評価は煩雑であり日常臨床に適さない.そこで13C 化合物を用いた新たな呼気膵外分泌機能検査法が検討された.13C 標識混合中性脂肪を用いた呼気検査法では7時間(または8時間)の13C累積回収率をもとに,またBenzoyl-L-Tyrosyl-[l-13C]Alanineを用いた呼気検査法では3時間の∆13CO2ピーク値をもとに膵外分泌機能不全を診断し,感度・特異度とも良好であった.13C 呼気試験は被検者が苦痛を伴わず安全で,反復も可能であり,膵外分泌機能不全の診断に有用である. |
Theme | The Functional Gastrointestinal Disorders -- Clinical Practice Based on the Understanding of Its Basic Mechanisms | |
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Title | Evaluation of Exocrine Pancreatic Function Employing 13C Breath Tests | |
Author | Atsufumi Matsumoto | Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine |
Author | Yusuke Tando | Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine |
Author | Miyuki Yanagimachi | Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine |
Author | Teruo Nakamura | Department of Health Science, Hirosaki University Graduate School of Medicine |
[ Summary ] | We defined exocrine pancreatic insufficiency as levels of over 5g of fecal fat excretion per day with meals having levels of fat higher than 40g/day. We should provide replacement therapy for patients with exocrine pancreatic insufficiency by administering pancreatic enzyme preparations. However, it is not easy to evaluate exocrine pancreatic insufficiency by determining fecal fat excretion. Because of this a new method for diagnosing exocrine pancreatic insufficiency was developed. This method was a breath test using 13C-labelled compounds. By employing a breath test using 13C-mixed neutral lipids, exocrine pancreatic insufficiency could be detected with 76.9% sensitivity and 100% specificity by determining recovery rates of cumulative 13C over a period of 7 to 8 hours. A breath test using 13C-mixed neutral lipids can be utilized to monitor the effects of pancreatic enzyme replacement. On the other hand, a breath test using Benzoyl-LTyrosyl-[l-13C] Alanine, can be used to determine exocrine pancreatic insufficiency with 93.8% sensitivity and 92.3% specificity with a ∆13CO2 peak value in 3 hours. These breath tests are very useful for diagnosing exocrine pancreatic insufficiency, because they are non-invasive, safe and repeatable methods. |