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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。
Objective To investigate the changes of total bile acid (TBA) in patients with alcoholic liver disease (ALD). Methods 105 ALD patients admitted to Department of Gastroenterology, the First Affiliated Hospital of Xi’an Jiaotong University School of Medicine from January 2007 to January 2010 were selected as ALD group. 105 ALD patients who consumed alcohol but did not suffer from ALD were selected as the control group. The correlation between TBA concentration and ALD was analyzed. The concentrations of TBA between ALD group and control group, ALD groups and alcoholic cirrhosis (AC) group and cirrhosis group were compared. Results The incidences of TBA> 20μmol / L and AST / ALT> 2 in ALD group were significantly higher than those in control group (56.19% vs 20.00%, 26.67% vs 11.43%, all P <0.01) Group [58.07 (24.00, 70.23) μmol / L vs. 19.27 (8.75, 32.16) μmol / L, P <0.01]; TBA was higher in AC and alcoholic AH group than in AFL group [ (60.74,103.00) μmol / L, 75.00 (21.76,110.28) μmol / L and 5.60 (2.79,15.81) μmol / L respectively, P <0.01]. The TBA concentration in AC group was higher than that in cirrhosis group [70.50 (32.00, 105.40) μmol / L vs. 19.70 (10.00, 27.31) μmol / L, P <0.01]. Conclusion TBA> 20μmol / L can be used to diagnose ALD, especially AH and AC. And is expected to include new diagnostic criteria for ALD.