血清胆汁酸谱在早期非酒精性脂肪性肝病患者中的临床意义  

Clinical significance of serum bile acid profile in patients with early non-alcoholic fatty liver disease

作　　者：孙皓月 许梦洁 吴乐灿 郑恩典 余颖聪 SUN Haoyue;XU Mengjie;WU Lecan;ZHENG Endian;YU Yingcong(Department of Gastroenterology,Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University,Wenzhou People’s Hospital,the Third Affiliated Hospital of Shanghai University,Wenzhou 325000,Zhejiang,China;Department of Laboratory Medicine,Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University,Wenzhou People’s Hospital,the Third Affiliated Hospital of Shanghai University,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州医科大学温州市第三临床学院,温州市人民医院,上海大学附属第三医院消化内科,浙江温州325000 [2]温州医科大学温州市第三临床学院,温州市人民医院,上海大学附属第三医院检验科,浙江温州325000

出　　处：《中国现代医生》2024年第36期28-33,共6页China Modern Doctor

基　　金：浙江省温州市科研项目(Y20210865)。

摘　　要：目的研究血清胆汁酸谱在早期非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)中的水平变化,并结合肝脏酶学指标,探讨其临床意义。方法选取2021年1月至2022年12月于温州市人民医院消化内科就诊的58例早期NAFLD患者为早期NAFLD组,同期选取66名健康体检者作为对照组。收集纳入者的基本信息及血液标本,采用超高效液相色谱-串联质谱法测定患者血清中的15种胆汁酸亚型,并结合肝脏酶学指标进行相关统计分析。结果与对照组相比,早期NAFLD组患者的血清牛磺胆酸(taurocholic acid,TCA)、牛磺鹅脱氧胆酸(taurochenodeoxycholic acid,TCDCA)含量显著升高,且与疾病相关性较高(SIMCA软件分析VIP>1,p(corr)>0.6);二元Logistic回归分析显示:体质量指数、总胆固醇、三酰甘油、TCA是早期NAFLD的独立危险因素,OR(95%CI)分别为2.367(1.511~3.709)、6.481(2.003~20.963)、4.950(1.675~14.631)、2.643(1.335~5.234)(TCA数值经log2转化),均P<0.05;受试者操作特征曲线显示:TCA、TCDCA在一定程度上可预测早期NAFLD的发生,且诊断评估能力均较高,其曲线下面积均>0.7。结论早期NAFLD患者胆汁酸谱成分发生变化,其中TCA、TCDCA水平升高,具有一定临床意义,有望成为早期NAFLD的血清标志物。Objective To investigate the changes of serum bile acid profiles in early non-alcoholic fatty liver disease(NAFLD)and explore their clinical significance at the same time combined with liver enzyme-related indicators.Methods A total of 58 patients with early NAFLD who were treated in Department of Gastroenterology,Wenzhou People’s Hospital from January 2021 to December 2022 were selected as early NAFLD group,along with 66 healthy individuals as control group.Basic information and blood samples were collected and ultra performance liquid chromatography-mass spectrometry/mass spectrometry was used to determine 15 types of serum bile acid profile.Statistical analysis was performed in correlation with liver enzyme indicators.Results Compared with control group,serum concentration of taurocholic acid(TCA)and taurochenodeoxycholic acid(TCDCA)increased in early NAFLD group,which were highly correlated with the disease(VIP>1,p(corr)>0.6 according to SIMCA software analysis).Binary Logistic regression analysis showed that body mass index,total cholesterol,triglyceride,and TCA were independent risk factors in the early-stage of NAFLD,with OR(95%CI)values of 2.367(1.511-3.709),6.481(2.003-20.963),4.950(1.675-14.631)and 2.643(1.335-5.234)(TCA values were log2 transformed),with all P<0.05.Receiver operating characteristic curve analysis showed that TCA and TCDCA had a certain predictive capability in diagnosis of the early NAFLD,and the diagnostic evaluation ability was higher,and area under the curve of them were more than 0.7.Conclusion The bile acid profile of patients with early NAFLD are changed,mainly TCA and TCDCA,which have a positive correlation with the early NAFLD and expected to become a serological marker of early NAFLD.

关 键 词：早期非酒精性脂肪性肝病 牛磺胆酸 牛磺脱氧胆酸 血清胆汁酸谱 

分 类 号：R575[医药卫生—消化系统]