从代谢组学角度探讨双重腹水超滤浓缩回输治疗肝肾阴虚型肝硬化腹水的机制  

Mechanism of Double Ascites with Ultrafiltration and Concentration Technique Treatment of the Liver and Kidney Yin Deficiency Liver Cirrhosis Ascites by Metabolomics

作　　者：顾欢 丛庆伟[1] 白长川 武春燕 朱英[1] Gu Huan;Cong Qingwei;Bai Changchuan;Wu Chunyan;Zhu Ying(Infectious Department,the First Affiliated Hospital of Dalian Medical University,and Liver Disease of Integrated Chinese and Western Medicine Department,Institute(College)of Integrative Medicine,Dalian Medical University,Dalian 116011,China;Dalian Hospital of Traditional Chinese Medicine,Dalian 116013,China)

机构地区：[1]大连医科大学附属第一医院感染科及大连医科大学中西医结合研究院中西医结合肝病科,大连116011 [2]大连市中医院,大连116013

出　　处：《世界中医药》2019年第12期3394-3399,共6页World Chinese Medicine

基　　金：国家自然科学基金项目(81673728)

摘　　要：目的:从代谢组学的角度探讨双重腹水超滤浓缩回输治疗肝肾阴虚型肝硬化腹水的机制。方法:选取2015年11月至2017年12月大连医科大学附属第一医院收治的肝硬化腹水患者38例作为研究对象,选取其中17例单纯肝硬化腹水患者,利用液质联用平台获得腹水超滤治疗前后患者的代谢物谱。利用偏最小二乘法-判别分析(Partial Least Square-Discrimination Analysis,PLS-DA)分析,筛选出差异代谢化合物并将其输入MetaboAnalyst获得相关代谢途径。结果:1)腹水回输治疗后,肝肾阴虚型患者中医证候较前改善;ALT、AST、TBIL较前下降(P<0.05),TP、ALB较前明显升高(P<0.01);Urea、Cre较前明显改善(P<0.01)。2)鉴定出与肝肾阴虚型肝硬化腹水回输治疗密切相关的5种化合物,包括鹅脱氧胆酸、胆酸、顺乌头酸、柠檬酸和棕榈酸,并得出与腹水回输治疗密切相关的3条代谢通路,包括柠檬酸循环、原发性胆汁酸生物合成和脂肪酸生物合成。结论:腹水回输治疗可能通过影响上述3条代谢通路取得有效临床疗效,为肝肾阴虚型肝硬化腹水的治疗提供新思路。Objective:To study the mechanism of double ascites with ultrafiltration and concentration technique treatment of the liver and kidney yin deficiency liver cirrhosis ascites by metabolomics.Methods:In this study,38 patients with cirrhosis ascites from the First Affiliated Hospital of Dalian Medical University during November 2015 to December 2017 were selected.The clinical effects of ascites reinfusion were observed and analyzed.17 patients with simple liver cirrhosis and ascites were selected,and the metabolite spectrum of the patients before and after ascites ultrafiltration treatment was obtained by LC/MS.Partial Least Square-Discrimination Analysis(PLS-DA)was used to screen out differential metabolic compounds and enter them into MetaboAnalyst to obtain relevant metabolic pathways.Results:After treatment,the TCM syndrome of patients with liver and kidney yin deficiency improved.The liver function ALT,AST and TBIL were decreased after treatment(P<0.05),and TP and ALB were increased after treatment(P<0.01).The renal function urea and creatinine were significantly improved after treatment(P<0.01).2)There were 5 compounds closely related to the treatment of ascites with liver and kidney yin deficiency by ascites with ultrafiltration and concentration technique treatment,including Chenodeoxycholic acid,Cholic acid,cis-aconitic acid,Citric acid and Palmitoleic acid.3 metabolic pathways were obtained that closely related to the treatment of ascites by ascites with ultrafiltration and concentration technique treatment,including citrate cycle(TCA cycle),primary bile acid biosynthesis and fatty acid biosynthesis.Conclusion:The treatment of ascites reinfusion can make effect through the 3 metabolic pathways.It provides a new idea for the treatment of ascites with liver and kidney yin deficiency syndrome.

关 键 词：双重腹水超滤浓缩回输 肝肾阴虚 肝硬化腹水 代谢组学 超高效液相色谱-质谱 差异代谢物 代谢通路 机制 

分 类 号：R242[医药卫生—中医临床基础] R285.6[医药卫生—中医学]