酒精性肝病总胆汁酸浓度变化研究

目的探讨酒精性肝病(ALD)患者总胆汁酸(TBA)变化特征。方法收集西安交通大学医学院第一附属医院消化内科2007年1月至2010年1月收治的105例ALD患者为ALD组,以同期105例饮酒但不患ALD者为对照组。分析TBA浓度与ALD的相关性;比较ALD组与对照组、ALD不同临床类型及酒精性肝硬化(AC)组和肝炎后肝硬化组之间TBA浓度。结果ALD组TBA>20μmol/L、AST/ALT>2的发生率均高与对照组(分别为56.19%对20.00%,26.67%对11.43%,均P<0.01);ALD组TBA浓度高于对照组58.07(24.00,70.23)μmol/L对19.27(8.75,32.16)μmol/L,P<0.01];TBA在AC组和酒精性肝炎(AH)组高于酒精性脂肪肝(AFL)组分别为60.74(35.29,103.00)μmol/L、75.00(21.76,110.28)μmol/L和5.60(2.79,15.81)μmol/L,P<0.01];AC组TBA浓度高于肝炎后肝硬化组70.50(32.00,105.40)μmol/L对19.70(10.00,27.31)μmol/L,P<0.01]。结论TBA>20μmol/L可用于ALD尤其是AH和AC的辅助诊断。并有望纳入ALD新的诊断标准。

Research for the concentration of TBA in alcoholic liver disease.

Objective To analyze changes of total bile acid(TBA) in patients with alcoholic liver disease(ALD).Methods The case group(ALD group) was made up of 105 in-patients with ALD,the control group was made up of 105 in-patients with drinking but withnot ALD.The clinical data of all subjects were collected from January 2007 to January 2010.The relevance between TBA and ALD was analyzed.Differences of TBA were compared between case and control groups,among different clinical types,and between AC group and hepatitis cirrhosis group.Results The incidence of TBA>20 μmol/L in the ALD group was 56.19%,which was higher than that of AST/ALT>2;The concentration of TBA in ALD group was higher than the control groupwhich were 58.07(24.00,70.23)μmol/L and 19.27(8.75,32.16)μmol/L,P<0.01];The concentration of TBA in AH and AC groups were higher than AFL groupwhich were 60.74(35.29,103.00)μmol/L,75.00(21.76,110.28)μmol/L and 5.60(2.79,15.81)μmol/L,P<0.01];The concentration of TBA in alcoholic cirrhosis group was higher than the hepatitis cirrhosis groupwhich were 70.50(32.00,105.40)μmol/L and 19.70(10.00,27.31)μmol/L,P<0.01].Conclusion TBA>20 μmol/L can be used for diagnosis of ALD as a new supplementary diagnostic indicator.It is especially appropriate to the diagnosis of AH and AC.TBA is likely to add in new diagnostic criteria for ALD.