摘要
目的探讨胆囊癌病人血清胆汁酸谱变化及其预警价值。方法收集2016年6月至2018年12月于上海交通大学医学院附属第六人民医院和仁济医院进行血清胆汁酸谱检测的796名健康体检者(健康组)和89例胆囊癌病人(胆囊癌组)的临床资料。回顾性分析健康组和胆囊癌组的15种血清胆汁酸成分的浓度差异,并采用受试者工作特征曲线和logistic回归分析筛选对胆囊癌有预警效能的胆汁酸。结果血清胆汁酸浓度不受性别和年龄的影响。胆囊癌组病人与健康组相比,血清甘氨结合型胆酸、甘氨结合型鹅脱氧胆酸、牛磺结合型胆酸、牛磺结合型鹅脱氧胆酸、石胆酸、甘氨结合型熊脱氧胆酸、牛磺结合型石胆酸和牛磺结合型熊脱氧胆酸浓度显著上升(中位数分别为770.64 nmol/L比124.12 nmol/L、2513.32 nmol/L比658.78 nmol/L、100.35 nmol/L比14.10 nmol/L、221.57 nmol/L比54.70 nmol/L、17.33 nmol/L比9.70 nmol/L、352.23 nmol/L比104.75 nmol/L、2.14 nmol/L比1.35 nmol/L、23.49 nmol/L比5.38 nmol/L),血清脱氧胆酸浓度显著降低(94.52 nmol/L比309.53 nmol/L),差异均有统计学意义(均P<0.05);血清游离/结合胆汁酸比例显著降低[0.24(0.02,0.61)比0.65(0.36,1.14),P<0.001]。其中,血清甘氨结合型胆酸对胆囊癌的预警效能最高,曲线下面积(area under curve,AUC)为0.818,灵敏度为71.59%、特异度为80.49%。甘氨结合型胆酸、甘氨结合型鹅脱氧胆酸、牛磺结合型胆酸、牛磺结合型鹅脱氧胆酸、脱氧胆酸、石胆酸、甘氨结合型熊脱氧胆酸、牛磺结合型石胆酸和牛磺结合型熊脱氧胆酸组成的联合指标,其预警效能进一步提高,AUC为0.903,灵敏度为83.10%,特异度为85.24%。结论胆囊癌病人的血清胆汁酸谱存在游离/结合胆汁酸比例降低的现象,检测血清胆汁酸浓度有可能成为胆囊癌的筛查手段之一。
Objective To explore the change of serum bile acid concentration and assess its clinical value of early warning in patients with gallbladder cancer(GC).Methods The relevant clinical data were collected from 89 GC patients and 796 healthy individuals undergoing serum bile acid testing from June 2016 to December 2018 at Sixth People′s Hospital and Renji Hospital.Retrospective analysis was performed to compare the concentrations of 15 serum bile acid components between healthy control and GC groups.The serum bile acids with early warning performance for GC were evaluated and screened by receiver operating characteristic(ROC)curve and Logistic regression analysis.Results Gender or age had no impact on serum bile acid concentrations in both healthy individuals and GC patients.Compared to healthy control group,GC patients had significantly elevated levels of serum glyocholic acid(GCA)(770.64 vs.124.12 nmol/L,P<0.001),glycochenodeoxycholic acid(GCDCA)(2513.32 vs.658.78 nmol/L,P<0.001),taurocholic acid(TCA)(100.35 vs.14.10 nmol/L,P<0.001),taurochenodeoxycholic acid(TCDCA)(221.57 vs.54.70 nmol/L,P<0.001),lithocholic acid(LCA)(17.33 vs.9.70 nmol/L,P=0.002),glycoursodeoxycholic acid(GUDCA)(352.23 vs.104.75 nmol/L,P<0.001),taurolithocholic acid(TLCA)(2.14 vs.1.35 nmol/L,P=0.030)and tauroursodeoxycholic acid(TUDCA)(23.49 vs.5.38 nmol/L,P<0.001).And they exhibited significantly lowered levels of serum deoxycholic acid(DCA)(94.52 vs.309.53 nmol/L,P<0.001)and a marked reduction in the ratio of serum free/conjugated bile acids from 0.65 to 0.24(P<0.001).Serum GCA had the highest early warning performance for GC with an area under curve(AUC)of 0.818,a sensitivity of 71.59%and a specificity of 80.49%.Additionally,the composite index composed of GCA,GCDCA,TCA,TCDCA,DCA,LCA,GUDCA,TLCA and TUDCA further improved the early warning performance for GC with an AUC of 0.903,a sensitivity of 83.10%and a specificity of 85.24%.Conclusion GC patients exhibit a reduced ratio of serum free/conjugated bile acids.Serum bile acid concentration testing holds significant potential as an important screening tool for GC.
作者
王伟
王湘钧
杨传鑫
王蒲雄志
余立钦
王坚
Wang Wei;Wang Xiangjun;Yang Chuanxin;Wangpu Xiongzhi;Yu Liqin;Wang Jian(Department of Hepatobiliary&Pancreatic Surgery,Affiliated Shanghai Sixth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Biliary-Pancreatic Surgery,Affiliated Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《腹部外科》
2023年第4期261-268,共8页
Journal of Abdominal Surgery
基金
国家自然科学基金(82273411,81974370,81402472)
上海市领军人才项目(2016)。
关键词
胆囊癌
胆汁酸
诊断
Gallbladder cancer
Bile acid
Diagnosis
