HEPATIC LIDOCAINE METABOLISM AND LIVER HISTOLOGY IN PATIENTS WITH CHRONIC HEPATITIS AND CIRRHOSIS

Recent advances in the medical and surgical treatment of chronic hepat itis and cirrhosis have made it increasingly important to develop noni nvasive tests of liver function. Our study has evaluated the hepatic c onversion of lidocaine to its primary metabolite monoethylglycinexylod ide and compared this with liver histological findings in 225 patients with chronic hepatitis (161 with hepatitis C, 23 with hepatitis B, 21 with autoimmune hepatitis and 20 with cryptogenic hepatitis). One hun dred seven (47.7%) patients had cirrhosis at the time of evaluation. A decline in monoethylglycinexylodide production was observed with wors ening liver histological conditions from a mean of 81.5 +/- 7.0 ng/ml in patients with chronic persistent hepatitis to 61.2 +/- 5.5 ng/ml fo r chronic active hepatitis and 20.9 +/- 1.5 ng/ml in patients with cir rhosis (p < 0.05). A further stepwise decline in monoethylglycine xylo dide production was observed with worsening Child class: from 25.5 +/- 2.2 ng/ml for class A patients to 8.9 +/- 1.4 ng/ml for patients with Child class C disease (p < 0.05). All patients with monoethylglycinex ylodide production less than 20 ng/ml had cirrhosis confirmed on histo logical examination. In contrast, no relationship was observed between liver histological status and serum transaminases (AST or ALT), bilir ubin, albumin and prothrombin time. Thirty-five patients underwent rep eat histological evaluation and monoethylglycinexylodide testing after receiving at least 6 mo treatment for chronic hepatitis (interferon f or hepatitis B and C and corticosteroids for autoimmune hepatitis). Th e change in monoethylglycinexylodide production observed in these pati ents was a linear function of the change in Knodell histological index (r = 0.73, p < 0.005). We conclude that hepatic monoethylglycinexylod ide production parallels liver histological condition in patients with chronic hepatitis and cirrhosis. Monoethylglycinexylodide testing may therefore prove to be a useful noninvasive test by which to monitor h epatic function and assess response to drug treatment in patients with chronic hepatitis.