血清胆汁酸谱对结直肠腺瘤的诊断价值

Diagnostic value of serum bile acid profile in colorectal adenoma

目的 分析结直肠腺瘤患者血清胆汁酸谱的组成变化,初步探讨血清胆汁酸谱对结直肠腺瘤的诊断价值。方法 纳入2021年11月至2022年4月南通大学附属江阴医院诊断的55例结直肠腺瘤患者作为观察组,并选择同期40例健康体检人群作为对照组。应用液相色谱串联质谱法测定外周血16型胆汁酸水平,采用多因素Logistic回归分析结直肠腺瘤患病危险因素。将组间有差异的指标纳入二元Logistic回归方程,建立诊断模型。采用受试者工作特征曲线(ROC)评估单项胆汁酸指标及诊断模型的诊断效能。结果 观察组患者的脱氧胆酸(DCA)、甘氨脱氧胆酸(GDCA)、牛磺脱氧胆酸(TDCA)水平分别为140.9 (124.7,157.0) ng/mL、69.0 (58.2,75.0) ng/mL、16.0 (10.4,24.4) ng/m L,明显高于对照组的126.2 (114.0,145.8) ng/mL、59.0 (55.0,71.7) ng/m L、9.3 (5.3,18.4) ng/mL,差异均有统计学意义(P<0.05);经Logistic回归分析结果显示,DCA≥122.1 ng/mL、TDCA≥14.6 ng/mL诊断结直肠腺瘤的OR值分别为4.426 (1.460~13.421)、2.777 (1.065~7.240);经ROC曲线分析结果显示,TDCA在单项指标中诊断结直肠腺瘤价值最高[曲线下面积(AUC)为0.671,敏感性为61.8%,特异性为72.5%],联合应用DCA及TDCA的诊断模型诊断结直肠腺瘤的AUC为0.724,敏感性为96.4%,特异性为42.5%。结论 DCA、GDCA、TDCA在结直肠腺瘤患者中高表达;TDCA联合DCA组成的诊断模型对结直肠腺瘤具有较高的诊断敏感性,为结直肠腺瘤的血清学筛查提供了新的思路。

Objective To analyze the compositional changes of serum bile acid profile in patients with colorectal adenomas,and initially investigate the diagnostic value of serum bile acid profiles for colorectal adenomas.Methods A total of 55 colorectal adenoma patients diagnosed at the Jiangyin Hospital Affiliated to Nantong Universi-ty between November 2021 and April 2022 were included as an observation group,and 40 healthy persons receiving physical examination during the same period were selected as the control group.Levels of bile acids in peripheral blood were measured by liquid chromatography tandem mass spectrometry.The risk factors of colorectal adenoma were analyzed by multivariate logistic regression.The indicators with differences between groups were included in the binary logistic regression equation to establish the diagnostic model.The receiver operating characteristic(ROC)curve were used to evaluate the diagnostic efficiency of single bile acid index and diagnostic model.Results The levels of deoxycholic acid(DCA),glymodeoxycholic acid(GDCA),and taodeoxycholic acid(TDCA)in the observation group were 140.9(124.7,157.0)ng/mL,69.0(58.2,75.0)ng/mL,16.0(10.4,24.4)ng/mL,which were significantly higher than 126.2(114.0,145.8)ng/mL,59.0(55.0,71.7)ng/mL,and 9.3(5.3,18.4)ng/mL in the control group(P<0.05).Lo-gistic regression analysis showed that the OR values of DCA≥122.1 ng/mL and TDCA≥14.6 ng/mL for the diagnosis of colorectal adenoma were 4.426(1.460-13.421)and 2.777(1.065-7.240).ROC curve analysis showed that TDCA had the highest value in the diagnosis of colorectal adenoma among the single indexes,with the area under curve(AUC)of 0.671,the sensitivity of 61.8%,the specificity of 72.5%.The diagnosis model of DCA combined with TDCA had better performance,with the AUC of 0.724,the sensitivity of 96.4%,and the specificity of 42.5%.Conclusion DCA,GDCA,and TDCA were highly expressed in patients with colorectal adenoma.The diagnostic model of TDCA combined with DCA showed high diagnostic sensitivity for colorectal adenoma,which provides a new idea for serological screening of colorectal adenoma.