胆汁酸谱在结直肠腺瘤诊断中的价值-现代医学

胆汁酸谱在结直肠腺瘤诊断中的价值

单位：南通大学附属江阴医院消化内科, 江苏江阴 214422

分类号：R735

出版年·卷·期（页码）：2023·51·第七期（906-911）

摘要：

目的: 研究结直肠腺瘤患者血清及粪便胆汁酸谱的组成变化,初步探讨胆汁酸谱在结直肠腺瘤诊断中的价值, 探索新型结直肠腺瘤筛查标记物。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例结直肠腺瘤患者及同期30例健康体检人群,应用液相色谱串联质谱法测定外周血及粪便16型胆汁酸水平,采用非参数检验比较胆汁酸谱的组成变化,绘制受试者工作特征(ROC)曲线评估胆汁酸的诊断效能,并根据约登指数得出截断值。结果: 腺瘤组患者的血清脱氧胆酸(DCA)、甘氨脱氧胆酸(GDCA)、牛磺脱氧胆酸(TDCA)水平分别为140.9 ng·ml^-1、69.0 ng·ml^-1、16.0 ng·ml^-1,明显高于对照组的129.0 ng·ml^-1、60.0 ng·ml^-1、9.1 ng·ml^-1;腺瘤组患者的粪便DCA、TDCA水平分别为2 190.0 ng·ml^-1、21.1 ng·ml^-1,明显高于对照组的1 600.0 ng·ml^-1、11.1 ng·ml^-1;腺瘤组患者的粪便熊去氧胆酸(UDCA)水平为15.3 ng·ml^-1,明显低于对照组的50.8 ng·ml^-1;差异均有统计学意义(P<0.05)。ROC曲线分析显示,粪便UDCA诊断结直肠腺瘤价值最高[曲线下面积(AUC)为0.718,灵敏度为70.9%,特异度为66.7%]。结论: 结直肠腺瘤患者的血清DCA、GDCA、TDCA及粪便DCA、TDCA高表达,粪便UDCA低表达。粪便UDCA诊断结直肠腺瘤价值最高,为结直肠腺瘤的生物学筛查提供了新的思路。

Objective: To investigate the compositional changes of serum and fecal bile acid profile in patients with colorectal adenoma and initially investigate the diagnostic value of bile acid profiles for colorectal adenoma. Methods: A total of 55 colorectal adenoma patients diagnosed at Jiangyin Hospital Affiliated to Nantong University from November 2021 to April 2022 were included, and 30 healthy persons receiving physical examination during the same period were selected. Levels of bile acids in peripheral blood and fecal were measured by liquid chromatography tandem mass spectrometry. The Mann Whitney nonparametric test was used to compare the compositional changes in bile acid profiles between the groups. The receiver operating characteristic(ROC)curve were used to evaluate the diagnostic efficiency of bile acid indexs. The truncation value was obtained according to the Joden index. Results: The levels of serum deoxycholic acid(DCA), serum glycodeoxycholic acid(GDCA)and serum taurodeoxycholic acid(TDCA)in the adenoma group were 140.9 ng·ml^-1, 69.0 ng·ml^-1, 16.0 ng·ml^-1, which were higher than 129.0 ng·ml^-1、60.0 ng·ml^-1、9.1 ng·ml^-1 in the control group(P<0.05). The levels of fecal DCA and TDCA in the adenoma group were 2 190.0 ng·ml^-1 and 21.1 ng·ml^-1, which were higher than 1 600.0 ng·ml^-1 and 11.1 ng·ml^-1 in the control group(P<0.05). The level of fecal ursodeoxycholic acid(UDCA) in the adenoma group was 15.3 ng·ml^-1, which was lower than 50.8 ng·ml^-1 in the control group(P<0.05). ROC curve analysis showed that fecal UDCA had the highest value in the diagnosis of colorectal adenoma among the single indexes of serum samples, the area under curve(AUC) was 0.718, the sensitivity was 70.9%, the specificity was 66.7%. Conclusion: DCA, GDCA, TDCA in serum and feces DCA, TDCA in feces were highly expressed in colorectal adenoma patients, while the expression of UDCA in feces was lowered in colorectal adenoma patients. Amongindicators of each sample, fecal UDCA has the highest value in the diagnosis of colorectal adenoma, which provides a new idea for biological screening of colorectal adenoma.

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