血清胆汁酸谱在肝病鉴别诊断中的应用研究

为探索血清胆汁酸谱在各种肝病中的特异性，用气相色谱法观察了黑索金，氯乙烯职业接触者及急性黄疸型肝炎、慢性活动型肝炎、肝硬化、肝癌等患者血清胆汁酸的变化情况。结果发现２种亲肝性毒物致肝损害时胆汁酸变化不同，黑索金接触者血清鹅脱氧胆酸（ＣＤＣＡ）、脱氧胆酸（ＤＣＡ）、石胆酸（ＬＣＡ）水平均升高，与对照组比较有显著性差异（Ｐ＜０．０５、Ｐ＜０．０１、Ｐ＜０．０１）；氯乙烯接触者则只有ＤＣＡ、ＬＣＡ水平升高，（Ｐ＜０．００１、Ｐ＜０．０００５）。其变化主要集中在次级胆汁酸上。急性黄疸型肝炎、慢性活动型肝炎、肝硬化、肝癌４种普通肝病血清ＣＡ、ＣＤＣＡ、ＤＣＡ和ＬＣＡ均有不同程度升高，以ＣＡ、ＣＤＣＡ变化较明显，与对照组比较其差异显著（Ｐ＜０．００５），但彼此间４种胆汁酸水平的变化都无显著性差异（Ｐ＞０．０５），而ＣＡ与ＣＤＣＡ比值互有不同，其差异有统计学意义，提示血清胆汁酸可用于鉴别诊断各型肝病。

Application of Serum Bile Acid Chromatography to the Diagnoses of Liver Diseases

In order to explore the specificity of serum bile acid (SBA) chromatograph in the diagnoses of different kinds of hepatosis, we investigated by means of gas chromatography the changes of serum bile acids in workers who exposed to hexogen or chloroethylene and in patients who suffered from hepatosis such as acute jaundice hepatitis, chronic active hepatitis, cirrhosis and liver cancer. The results revealed different disturbances of SBA occurring in the liver injuries induced by the two kinds of hepatotoxicant. Serum lithocholic acid (LCA), deoxycholic acid (DCA) and chenodeoxycholic acid (CDCA) in worders exposed to hexogen and wre significantly different from those of the control group respectively ( P< 0.01, P<0.01, P<0.05 ); on the other hand, only serum LCA and DCA went up in workers exposed to chloroethylene ( P<0.0005, P<0.001) . The main changes both concentrated on the secondary bile acids. In acute jaundice hepatitis, chronic active hepatitis, cirrhosis and liver cancer, serum LCA, DCA, CDCA and cholic acids (CA) all went up in different degrees compared with the control group respectively ( P< 0.005, P<0.025, P<0.005, P<0.005) . But no difference was noted among the 4 kinds of bile acids ( P> 0.5 ), except that between CA and CDCA. These provided the evidence of the diagnosis and identification of clinical hepato biliary diseases and occupational liver injures.