胆汁酸谱在肺炎和肺癌鉴别诊断中的应用价值

目的 探讨肺癌患者血清胆汁酸谱的变化及其在肺炎与肺癌鉴别诊断中的价值.方法 采用液相色谱-串联质谱法(LC-MS/MS)检测80例肺炎患者(肺炎组)、108例肺癌患者(肺癌组)和106名体检健康者(正常对照组)血清胆汁酸谱5种游离胆汁酸,包括胆酸(CA)、鹅脱氧胆酸(CDCA)、脱氧胆酸(DCA)、石胆酸(LCA)、...

Application of serum bile acid spectrum in the differential diagnosis of pneumonia and lung cancer

Objective To investigate the changes of serum bile acid spectrum in patients with lung cancer and its value in the differential diagnosis of pneumonia and lung cancer.Methods Serum bile acid spectrum of 80 patients with pneumonia(pneumonia group),108 patients with lung cancer(lung cancer group)and 106 healthy subjects(healthy control group)were determined by liquid chromatography-tandem mass spectrometry(LCMS/MS),including 5 free bile acidscholic acid(CA),chenodeoxycholic acid(CDCA),deoxycholic acid(DCA),lithocholic acid(LCA),ursodeoxycholic acid(UDCA)]and 10 conjugated bile acidsglycocholic acid(GCA),glycochenodeoxycholic acid(GCDCA),glycodesoxycholic acid(GDCA),glycolithocholic acid(GLCA),glycoursodeoxycholic acid(GUDCA),taurocholic acid(TCA),taurochenodeoxycholic acid(TCDCA),taurodeoxycholic acid(TDCA),taurolithocholic acid(TLCA)and tauroursodeoxycholic acid(TUDCA)].Serum total bile acid(TBA)and tumor markers,such as carbohydrate antigen(CA)125,CA19-9,carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CYFRA 21-1)and neuron specific enolase(NSE),were also determined.Logistic regression was used to screen items,and the diagnosis model was established.Receiver operating characteristic(ROC)curve was used to analyze the performance of these items and diagnosis model in the differential diagnostic of pneumonia and lung cancer.Results Compared with healthy control group,the levels of DCA,LCA,UDCA,GDCA,GLCA,TDCA,and TLCA decreased in pneumonia group(P<0.01),while GCDCA and TCDCA increased(P<0.01);CA,CDCA,GCDCA,and TCDCA increased in lung cancer group(P<0.01),while TDCA and TLCA decreased(P<0.01).There was no statistical significance in the level of serum TBA among the 3 groups(P>0.05).The levels of CA,CDCA,DCA,LCA,UDCA,GDCA,GLCA,CEA,and CYFRA21-1 in lung cancer group were significantly higher than those in pneumonia group(P<0.01).ROC curve analysis showed that DCA had the best performance in the differential diagnosis of pneumonia and lung cancer among all the single itemsthe area under curve(AUC)of 0.781,the sensitivity of 73.2%,the specificity of 77.5%and the Youden index of 0.51].The diagnosis model had good performance with the AUC of 0.873,the optimal cut-off value of 0.52,the sensitivity of 89.3%and the specificity of 75.4%.Conclusion The changes of bile acid spectrum are closely associated with the occurrence of lung diseases.Bile acid spectrum is potential as diagnostic markers for lung cancer.