血浆胆汁酸在肝肿瘤中的差异分析及应用价值  

Differences and application value of plasma bile acids in tum0ors of the liver

作　　者：贾茹 张平平 袁苑 胡义扬[4,5,6] 冯琴 JIA Ru;ZHANG Pingping;YUAN Yuan;HU Yiyang;FENG Qin(Department of Oncology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Technical Experimental Center,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;School of Integrative Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Institute of Liver Diseases,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Shanghai Key Laboratory of Traditional Chinese Medicine,Shanghai 201203,China;Key Laboratory of Liver and Kidney Diseases,Ministry of Education,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院肿瘤科,上海201203 [2]上海中医药大学附属曙光医院科技实验中心,上海201203 [3]上海中医药大学中西医结合学院,上海201203 [4]上海中医药大学肝病研究所,上海201203 [5]上海市中医临床重点实验室,上海201203 [6]肝肾疾病病证教育部重点实验室,上海201203

出　　处：《临床肝胆病杂志》2024年第10期2042-2048,共7页Journal of Clinical Hepatology

基　　金：国家自然科学基金(82104619);上海市卫健委卫生行业临床研究专项(20214Y0455);上海中医药大学预算内项目(2021LK105)。

摘　　要：目的分析原发性肝癌与转移性肝癌患者血浆胆汁酸水平及其与临床指标的相关性,并评估其联合AFP对于原发性肝癌的诊断价值。方法纳入2020年8月—2021年9月于上海中医药大学附属曙光医院就诊且具有组织病理学及影像学明确的75例原发性肝癌患者及79例转移性肝癌患者,采集外周血并分别分离血清及血浆,比色法及色谱法检测生化指标,电化学发光免疫分析法检测肿瘤标志物水平,高效液相色谱-串联质谱法检测胆汁酸含量。符合正态分布的计量资料两组间比较采用成组t检验,不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。相关性检验采用Spearman相关分析。临床诊断效能采用受试者工作特征曲线(ROC曲线)评估。结果原发性肝癌组患者TC、TG、LDL-C及载脂蛋白(Apo)B显著低于转移性肝癌组患者,差异均具有统计学意义(U值分别为1598、1255、909、889,P值均<0.05)。原发性肝癌组患者AFP显著高于转移性肝癌组患者,癌胚抗原(CEA)显著低于转移性肝癌组患者,差异均具有统计学意义(U值分别为1873、926,P值均<0.05)。原发性肝癌组患者总胆汁酸(TBA)、胆酸(CA)、鹅脱氧胆酸(CDCA)、熊脱氧胆酸(UDCA)、牛磺胆酸(TCA)、牛磺鹅脱氧胆酸(TCDCA)、甘氨胆酸(GCA)、甘氨鹅脱氧胆酸(GCDCA)、牛磺熊脱氧胆酸(TUDCA)、甘氨熊脱氧胆酸(GUDCA)均显著高于转移性肝癌患者,脱氧胆酸(DCA)显著低于转移性肝癌患者,差异均具有统计学意义(P值均<0.05)。总人群中TBA、CDCA、GCA、GCDCA、GUDCA、TCA、TCDCA及TUDCA含量与AFP水平呈显著正相关(P值均<0.05)。原发性肝癌患者中GCA、TCA、TCDCA及TUDCA含量与AFP水平呈显著正相关(P值均<0.05)。AFP+TCA+GCA+TCDCA联合检测的AUC为0.822(95%CI:0.746~0.898,P<0.0001),效能最高。结论原发性肝癌与转移性肝癌患者血浆胆汁酸含量具有显著差异,差异性胆汁酸与肝损伤及AFP升高密切相关,联合Objective To investigate the levels of plasma bile acids(BA)in patients with primary liver cancer(PLC)or metastatic liver cancer(MLC)and their correlation with clinical indicators,as well as the value of plasma BAs combined with alpha-fetoprotein(AFP)in the diagnosis of PLC.Methods This study was conducted among 75 patients with PLC and 79 patients with MLC who attended Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2020 to September 2021 and had a confirmed diagnosis based on histopathological and imaging findings.Peripheral blood samples were collected from all patients,and serum and plasma were separated.Colorimetry and chromatography were used to measure biochemical parameters;electrochemiluminescence immunoassay was used to measure the levels of tumor markers;liquid chromatography-tandem mass spectrometry was used to measure the content of BA.The t-test was used for comparison of normally distributed continuous data,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data;the Spearman’s coefficient was used for correlation analysis;the receiver operating characteristic(ROC)curve was used to evaluate clinical diagnostic efficacy.Results The PLC group had significantly lower levels of total cholesterol,triglyceride,lowdensity lipoprotein cholesterol,and apolipoprotein B than the MLC group(U=1598,1255,909,and 889,all P<0.05).Compared with the MLC group,the PLC group had a significantly higher level of AFP and a significantly lower level of carcinoembryonic antigen(U=1873 and 926,both P<0.05).Compared with the MLC group,the PLC group had significantly higher levels of TBA,CA,CDCA,UDCA,TCA,TCDCA,GCA,GCDCA,TUDCA,and GUDCA and a significantly lower level of DCA(all P<0.05).In the total population,the levels of TBA,CDCA,GCA,GCDCA,GUDCA,TCA,TCDCA,and TUDCA were significantly positively correlated with the level of AFP(all P<0.05).In the patients with PLC,the levels of GCA,TCA,TCDCA,and TUDCA were significantly positively correla

关 键 词：胆汁酸类和盐类 肝肿瘤 肿瘤转移 

分 类 号：R735.7[医药卫生—肿瘤]