血清胆汁酸谱系测定在肝硬化诊断中的应用价值

Application value of serum bile acid lineage measurement in diagnosis of cirrhosis

目的:通过比较肝硬化患者与健康对照组血清中胆汁酸谱系的变化,探索胆汁酸谱系的测定在判断肝损伤、提示早期肝硬化、明确肝硬化临床分级及治疗中的应用价值。方法:将临床诊断为肝硬化的34例患者作为观察组,另选50例健康体检者作为正常对照组,用液相色谱-串联质谱法分别测定两组血清样本中5种未结合型胆汁酸及10种结合型胆汁酸的含量并进行比较分析。结果:与正常对照组相比,肝硬化组血清胆汁酸谱系检测值中未结合胆汁酸含量减少,结合胆汁酸含量明显增多(P<0.05)。正常对照组与肝硬化组Child-Pugh A分级间胆汁酸谱系含量差异有统计学意义(P<0.05);不同Child-Pugh分级中,以甘氨胆酸(GCA)、牛磺胆酸(TCA)为主的8种胆汁酸会随着肝脏Child-Pugh分级的升高呈现出递增的趋势(P<0.05);胆汁酸谱系诊断评估中诊断能力较高的有TCA(AUC=0.956),其次为牛磺鹅脱氧胆酸(TCDCA)(AUC=0.916)、GCA(AUC=0.912.,阳性率比总胆汁酸、白蛋白、胆红素及凝血酶原高。结论:胆汁酸谱系可早期诊断肝损伤及提示早期肝硬化,并可作为Child-Pugh分级的有效补充。

Aim:By comparing the changes of serum bile acid lineage in patients with liver cirrhosis and healthy controls,the application value of the determination of bile acid lineage in judging liver injury,suggesting early cirrhosis,and deciding the clinical classification and treatment of cirrhosis was explored.Methods:Thirty-four patients with cirrhosis were chosen as observation group,and 50 healthy subjects,as normal control group.Tandem mass spectrometry LC-MS was used to determine 5 types of unbound bile acid and 10 types of bound bile acid in serum samples.Results:Compared with normal control group,the unbound bile acid content in the observation group was reduced,while the bound bile acid content was increased(P<0.05).There was a difference in bile acid lineage between the normal control group and patients with the Child-Pugh A grade(P<0.05).Among the patients with different Child-Pugh classifications,8 kinds of bile acid especially glycocholic acid(GCA)and taurocholic acid(TCA)showed an increasing trend with the increase of Child-Pugh classification in the liver(P<0.05).Among the bile acid lineage,TCA had the highest diagnostic value for cirrhosis(AUC=0.956),followed by tauro-chenodeoxycholic acid(TCDCA)(AUC=0.916)and GCA(AUC=0.912..Their positive rates of diagnosis were higher than total bile acid,albumin,bilirubin and prothrombin.Conclusion:Bile acid lineage could be used in diagnosis of early liver injury and suggest early cirrhosis,and can be used as an effective supplement to Child-Pugh classification.