Inducibility of microsomal liver function may differentiate cirrhotic patients with maintained compared with severely compromised liver reserve.
OBJECTIVE
Quantitative tests of liver function (QTLF) can be modulated by enzyme-inducing agents. The objective of the study was to examine changes in QTLF after treatment with Phenobarbital, a potent cytochrome P450-inducing agent.


METHODS
Forty-six consecutive patients with liver cirrhosis Child-Pugh score B and C (34 alcoholic, 12 hepatitis C) and a compromised aminopyrine breath test (ABT) were included. Thirty-six patients (group I) received phenobarbitone (150 mg) for 7 days. Ten patients (group II) received a placebo. The QTLF, which included ABT (microsomal liver function), galactose elimination capacity (GEC, cytosolic liver function), sorbitol clearance (SCl, liver plasma flow) and indocyanine green clearance (ICG, liver perfusion) was carried out before and after pharmacological induction.


RESULTS
Group I showed a basal ABT of 0.18 +/- 0.11% dose.kg/mmol CO2 (normal >0.6%), which increased significantly after induction (172%, P < 0.05), whereas in group II the ABT values did not change. In group IB, a subgroup of group I which exceeded the basal threshold value of 0.30% after stimulation (n = 22), the ABT values increased significantly to 0.44 +/- 0.17% (244%, P < 0.01). The GEC, SCl and ICG remained unchanged before and after induction.


CONCLUSIONS
After pharmacological induction, microsomal liver function increased significantly in a subgroup of patients with liver cirrhosis, whereas the GEC, SCl and ICG remained unchanged. Inducibility of the microsomal liver function could be used as a novel parameter of functional hepatic reserve and prognosis in cirrhosis.
Herold
Chirstoph
C
Department of Medicine I, Unviersity of Erlangen-Nuernberg, Erlangen Germany. christoph.herold@med1.imed.uni-erlangen.de
Ganslmayer
Marion
M
Ocker
Matthias
M
Zopf
Steffen
S
Gailer
Barbara
B
Hahn
Eckhart G
EG
Schuppan
Detlef
D
D000328:Adult; D000927:Anticonvulsants / Q000494:pharmacology*; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects / Q000502:physiology; D003937:Diagnosis, Differential; D004790:Enzyme Induction / Q000187:drug effects / Q000502:physiology; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000175:diagnosis / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008862:Microsomes, Liver / Q000187:drug effects* / Q000502:physiology*; D008875:Middle Aged; D010634:Phenobarbital / Q000494:pharmacology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index
D000927:Anticonvulsants; D003577:Cytochrome P-450 Enzyme System; D010634:Phenobarbital