白毒伞致胆汁酸代谢产物的变化对预后的影响

The changes of bile acid metabolites effect on the prognosis in poisoning of Amanita verna

目的通过分析白毒伞中毒患者胆汁酸代谢产物变化,证实胆汁酸代谢产物的变化可以用于判断患者预后及指导治疗。方法采用高效液相色谱联合质谱技术检测了5例不同预后的白毒伞中毒患者的多种胆汁酸代谢产物。结果白毒伞中毒患者的胆汁酸代谢产物与健康对照组有很大差异;死亡患者与治愈患者的胆汁酸代谢产物也不相同;二者之间的差异在食后第4天就明显地表现出来。恢复期患者的胆汁酸代谢产物与对照组仍有很大差异。经分子量测定、数据库筛查及统计学处理后,患者与健康对照组之间差异最大的胆汁酸代谢产物为甘氨结合脱氧胆酸(GDCA)、甘氨结合鹅脱氧胆氧(GCDCA)、甘氨胆酸(GCA)及甘氨熊脱氧胆酸(GUDCA),并在患者组明显增加。结论GDCA、GCDCA、GCA及GUDCA可以指示白毒伞中毒程度及预后。

Objective Selecting some bile acid metabolites used as potential maker to indicate prognosis and treatment by analyzing the changes of bile acid metabolites to patients of consuming amanita verna. Methods Detecting bile acid metabolites with high performance liquid chromatography- mass spectrometry （HPLCMS） to serum samples of five patients of consuming amanita verna. Results Bile acid metabolites were different between the patients and the healthy controls, even the dead patients and the cured patients. On the fourth day of consuming amanita verna, the bile acid metabolites of the dead patients were markedly different from those of the cured patients. The bile acid metabolites of the cured patients in the cured stage were different from those of the healthy controls too. The markedly different metabolites between patients and healthy controls were Glycodeoxycholic acid （GDCA） , glycochenodeoxycholic acid （GCDCA） , glycocholic acid （GCA） , and glycoursodeoxycholic acid （GUDCA） differentiated with mass - spectrometry according to their molecular masses. Conclusions GDCA, GCDCA, GCA, and GUDCA might be used as potential markers to indicate degree of amanita verna poisoning and prognosis of patients.