结直肠癌肝转移患者的血浆胆汁酸谱特征研究及临床价值探讨

摘要：目的 分析不同转移情况结直肠癌患者血浆胆汁酸含量及胆汁酸谱分布差异，并评估血浆胆汁酸比值联合肿瘤标志物在诊断结直肠癌肝转移中的临床应用价值。方法 于2021年4月至2022年1月纳入上海中医药大学附属曙光医院就诊的结直肠腺癌患者共163例，根据是否出现肝转移分为无转移组（82例）和肝转移组（81例），采集临床资料及外周血样本，用高效液相色谱-串联质谱法检测血浆15种胆汁酸含量，用KPS评分评估生存质量，比较两组患者胆汁酸含量及胆汁酸谱分布差异，并绘制ROC曲线分析胆汁酸比值联合肿瘤标志物 详写！对结直肠癌肝转移的临床诊断效能。结果 两组患者年龄、性别、发病部位、病理分化程度、KPS评分差异无统计学意义（均P>0.05）。结直肠癌肝转移患者总胆汁酸、CEA、CA125均较无转移患者升高（均P <0.05）；结直肠癌肝转移患者血浆胆汁酸谱中GCA、DCA、TDCA、GDCA、GUDCA、LCA及GLCA含量均较无转移组患者升高（均P <0.01）；结直肠癌肝转移患者血浆次级胆汁酸含量高于无转移患者（P<0.001），次级胆汁酸与初级胆汁酸含量比值高于无转移组患者（P<0.001）。次级胆汁酸与初级胆汁酸含量比值联合CEA、CA125诊断结直肠癌肝转移的灵敏度为71.60%，特异度为80.49%，AUC为0.820 (95%CI: 0.754~0.885, P<0.001)。结论 结直肠癌肝转移患者血浆胆汁酸含量升高，胆汁酸谱异于无转移患者，次级胆汁酸与初级胆汁酸含量比值联合CEA、CA125对于结直肠癌肝转移有较高的临床诊断意义。

Distribution characteristic and clinical value of plasma bile acid in patients with colorectal cancer liver metastasisJIA Ru1, Zhang Pingping1, YUAN Yuan2, WANG Yan1, LI Qi3,4

Objective To analyze and the difference of plasma bile acid (BA) concentration and BA spectrum distribution in colorectal cancer patients with varying metastatic conditions, and to evaluate the clinical application value of plasma BA ratio combined with tumor markers in the diagnosis of colorectal cancer liver metastasis (CRCLM). Methods A total of 163 patients diagnosed with colorectal cancer were enrolled in the study between April 2021 and January 2022. They were categorized into two groups: a non-metastatic group (CRC-NM group, N=82 cases) and a liver metastasis group (CRC-LM group, N=81 cases), based on the presence or absence of liver metastases. Clinical data and peripheral blood samples were collected from all participants. The concentrations of 15 different BAs in plasma were measured using HPLC/tandem mass spectrometry. The study compared the differences in BA concentration and BA spectrum distribution between the two groups. Additionally, a receiver operating characteristic (ROC) curve was generated to evaluate the clinical diagnostic efficacy of the BA ratio combined with tumor markers in diagnosing CRCLM. Results In patients with CRCLM, the concentrations of total bile acid (TBA), CEA and CA125 were significantly higher compared to those without metastasis (all P<0.05). Additionally, the concentrations of GCA, DCA, TDCA, GDCA, GUDCA, LCA, and GLCA in patients with CRCLM were elevated compared to patients without metastasis (all P<0.05). Furthermore, the plasma concentration of secondary bile acid (SBA) in CRCLM patients was significantly higher than in non-metastatic patients (P<0.05), and the ratio of SBA to primary bile acid (PBA) was also higher in CRCLM patients (P<0.05). Combining the SBA/PBA ratio with CEA and CA125 yielded a sensitivity of 71.60%, a specificity of 80.49%, and an AUC of 0.820 (95%CI: 0.754~0.885, P<0.05). Conclusion The plasma BA concentration was elevated in patients with CRCLM, and the BA profile exhibited notable differences compared to patients without metastasis. The SBA/PBA ratio combined with CEA and CA125 demonstrated significant clinical significance for diagnosing CRCLM.