Measuring lidocaine metabolite — monoethylglycinexylidide as a quantitative index of hepatic function in adults with chronic hepatitis and cirrhosis

Huang, Yi-Hsiang; Lee, Shou‐Dong; Deng, Jou‐Fang; Wu, Jaw‐Ching; Lu, Renhua; Lin, Yi-Fang; Wang, Yuan‐Jen; Lo, Kwang‐Juei

doi:10.1016/s0168-8278(05)80187-4

Cited by 71 publications

(40 citation statements)

References 19 publications

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“…The search for such a test has been going on for many years and is complicated by the lack of a universally accepted standard. The formation of monoethylglycinexylidide (MEGX), the main lidocaine metabolite, has been suggested as a simple and valuable liver function test (22)(23)(24). However, the administration of lidocaine may produce side effects in a high percentage of individuals tested (22), the formation of MEGX may be influenced by age and gender (24,25), and the lidocaine dose to be administered and the time point for measuring the MEGX concentration are still controversial (26)(27)(28).…”

Section: Resultsmentioning

confidence: 99%

Plasma hydroxy-metronidazole/ metronidazole ratio in hepatitis C virus-induced liver disease

Marchioretto

Ecclissato

Silva

et al. 2005

Braz J Med Biol Res

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It has been suggested that the measurement of metronidazole clearance is a sensitive method for evaluating liver function. The aim of this study was to evaluate the usefulness of plasma hydroxy-metronidazole/metronidazole ratios as indicators of dynamic liver function to detect changes resulting from the various forms of chronic hepatitis C virus (HCV) infection. A total of 139 individuals were studied: 14 healthy volunteers, 22 healthy, asymptomatic, consecutive anti-HCVpositive HCV-RNA negative subjects, 81 patients with chronic hepatitis C (49 with moderate/severe chronic hepatitis and 34 with mild hepatitis), and 20 patients with cirrhosis of the liver. HCV status was determined by the polymerase chain reaction. Plasma concentrations of metronidazole and its hydroxy-metabolite were measured by reverse-phase high-performance liquid chromatography with ultraviolet detection in a blood sample collected 10 min after the end of a metronidazole infusion. Anti-HCV-positive HCV-RNA-negative individuals demonstrated a significantly reduced capacity to metabolize intravenously infused metronidazole compared to healthy individuals (0.0478 ± 0.0044 vs 0.0742 ± 0.0232). Liver cirrhosis patients also had a reduced plasma hydroxy-metronidazole/metronidazole ratio when compared to the other groups of anti-HCV-positive individuals (0.0300 ± 0.0032 vs 0.0438 ± 0.0027 (moderate/severe chronic hepatitis) vs 0.0455 ± 0.0026 (mild chronic hepatitis) and vs 0.0478 ± 0.0044 (anti-HCV-positive, HCV-RNA-negative individuals)). These results suggest an impairment of the metronidazole metabolizing system induced by HCV infection that lasts after viral clearance. In those patients with chronic hepatitis C, this impairment is paralleled by progression of the disease to liver cirrhosis.

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Section: Resultsmentioning

confidence: 99%

Plasma hydroxy-metronidazole/ metronidazole ratio in hepatitis C virus-induced liver disease

Marchioretto

Ecclissato

Silva

et al. 2005

Braz J Med Biol Res

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“…This test has been used in several studies as a quantitative index of hepatic functions [30]. It has been reported that the hepatic metabolism of Lidocaïne to Monoethylglycinexylidide (MEGX) is the basis of dynamic tests of liver function and that it is more discriminatory and recognizes early damage to the liver than con ventional individual liver function tests and it shows a good cor relation with severity of liver injuries [31][32][33].…”

Section: Liver Ischemia-reperfusionmentioning

confidence: 99%

Effect of Myrtus Communis L. Extracts on Attenuation of Liver Normothermic Ischemia-Reperfusion Injury

Ferchichi¹

2012

J Transplant Technol

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The Common Myrtle (Myrtus communis L.) is rich in antioxidants, particularly in anthocyanin. It was recognized for its anti-inflammatory and anti-thrombotic effects.The aim of our work is to evaluate the effect of Common Myrtle on a model of hepatic ischemia-reperfusion in Rat.Two morphs were chosen: white fruit Myrtle and black fruit Myrtle. Within each morph, fruit and leaf were separated and obtained extract were used to determine their effects on the hepatic model of ischemia-reperfusion.Our work was conducted in three steps (1) Induction of hepatic ischemia (90 minutes) in Wistar Rat (2) injection of the Myrtle extract during 15 minutes before reperfusion (3) and reperfusion (2 hours).To evaluate the effect of Myrtle on ischemia-reperfusion, we have monitored transaminases levels, Monoethylglycinexylidide (MEGX) concentrations (to assess the liver metabolic capacity) and Malondialdehyde (MDA) concentration.The determination of total phenol extracts of Myrtle showed a significant difference between black fruit Myrtle (11.3 µg/ml), white fruit (27 µg/ml) and black fruit Myrtle leaves (94.3 µg/ml). The latter presented the highest antioxidant activity (86.54%).With the extract from the white fruit of Myrtle, we noted a decrease of AST and ALT, respectively, 1321 U/I and 773 U/I compared with I/R group was 5757 U/I and 5404 U/I and an increase in the MEGX concentrations and decrease in MDA.The testing of extracts of Myrtle in a model of hepatic ischemia showed a difference in the protective power against damage of ischemia-reperfusion, by origin and type of fruit (black or white).

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“…duce the lidocaine-induced side effects, we evaluated the The majority of authors have reported a low preva-MEG-X formation after 0.5 and 1 mg/kg lidocaine intravelence. 3,4,8,10,11 Only one study reported side effects in almost nously in subjects with normal (n Å 5) and severely imall tested individuals. 9 Surprisingly, the symptoms following paired liver function (n Å 7) (study I).…”

mentioning

confidence: 99%

“…[4][5][6][7] Other The hepatic metabolism of lidocaine (1 mg/kg intravestudies have speculated that the test could replace histology nously) to its metabolite monoethylglycinexylidide for the diagnosis of cirrhosis. [8][9][10] However, in addition to the (MEG-X) is the basis of the standard MEG-X test.…”

mentioning

confidence: 99%

The low-dose monoethylglycinexylidide test: Assessment of liver function with fewer side effects

et al. 1997

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tients with chronic active hepatitis and cirrhosis. [4][5][6][7] Other The hepatic metabolism of lidocaine (1 mg/kg intravestudies have speculated that the test could replace histology nously) to its metabolite monoethylglycinexylidide for the diagnosis of cirrhosis. [8][9][10] However, in addition to the (MEG-X) is the basis of the standard MEG-X test. To retest's diagnostic value, its side effects must be considered. duce the lidocaine-induced side effects, we evaluated the The majority of authors have reported a low preva-MEG-X formation after 0.5 and 1 mg/kg lidocaine intravelence. 3,4,8,10,11 Only one study reported side effects in almost nously in subjects with normal (n Å 5) and severely imall tested individuals. 9 Surprisingly, the symptoms following paired liver function (n Å 7) (study I). From this study, lidocaine injection were not related to the degree of hepatic a low-dose test (MEG-X concentration 30 minutes after histological changes or to the Child class. 9 Because of these 50 mg lidocaine intravenously [MEG-X 30min ] normalized contradictory findings, the safety of the MEG-X test has been to standard MEG-X test results) was developed. Sensory questioned, and further studies were recommended. 12,13 Most side effects from this low dose and from the standard lidocaine-induced side effects are dose-dependent. In con-MEG-X test were compared in a double-blind, randomtrast, lidocaine clearance and the MEG-X formation rate are ized, cross-over study (study II) comprising 15 individudose-independent. 14 To date, it has not been evaluated als with normal liver function and 45 patients with cirwhether this first-order kinetic model holds true for patients rhosis (15 Child A, 15 Child B, and 15 Child C). In study I, with advanced cirrhosis. If this were the case, it should be MEG-X formation rate was dose-independent in patients possible to reduce side effects by extrapolating MEG-X values with severely impaired liver function. In study II, norobtained with lower lidocaine doses to standard MEG-X test malized MEG-X test results (ranging from°4 to 120 mg/ results. Therefore, we studied (study I) the dose-dependent L) were virtually identical to the standard test results pharmacokinetics of lidocaine in patients with severely im-(mean difference: 01.9 mg/L; 95% confidence interval paired liver function. In a second double-blind randomized [CI]: 05.3; 1.5 mg/L). Fewer individuals experienced side controlled study (study II), we assessed the sensory quality effects (30% vs. 53%) with the low-dose test (P Å .0013).and intensity of patients' side effects with the aim of finding In a multivariate analysis, the Child-Pugh score was intheir relationship to lidocaine dosage and liver function. and 0.5 mg/kg body weight to individuals with normal (n Å 5) and severely impaired liver function (n Å 7). To compare the low-dose versus the standard MEG-X test (study II: double-blind, randomized, Lidocaine is metabolized to its principal metabolite, monocross-over design), we injected 1 mg/kg body weight lidocaine and 50 ...

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Measuring lidocaine metabolite — monoethylglycinexylidide as a quantitative index of hepatic function in adults with chronic hepatitis and cirrhosis

Cited by 71 publications

References 19 publications

Plasma hydroxy-metronidazole/ metronidazole ratio in hepatitis C virus-induced liver disease

Plasma hydroxy-metronidazole/ metronidazole ratio in hepatitis C virus-induced liver disease

Effect of Myrtus Communis L. Extracts on Attenuation of Liver Normothermic Ischemia-Reperfusion Injury

The low-dose monoethylglycinexylidide test: Assessment of liver function with fewer side effects

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