Amuro Y, Endo T, Higashino K, Uchida K, Yamamura Y
Clin Chim Acta. 1981 Aug 10;114(2-3):137-47. doi: 10.1016/0009-8981(81)90387-9.
The urinary and fecal bile acids of thirteen male patients with liver cirrhosis were analyzed by gas chromatography and gas chromatography-mass spectrometry to obtain information on their keto bile acid excretion. 3 alpha-Hydroxy-12-keto-5 beta-cholanoic, 3 alpha,12 alpha-dihydroxy-7-keto-5 beta-cholanoic, 3 alpha,7 alpha-dihydroxy-12-keto-5 beta-cholanoic and 3 alpha-hydroxy-7,12-diketo-5 beta-cholanoic acids were found in the urine of ten patients. In four of these patients, keto bile acids were the main bile acids excreted in the urine. However, the ratios of fecal keto bile acids to the total fecal bile acids in these four patients were similar to those in the other six patients whose urinary excretion of keto bile acids was low. Three of the four patients had clinical abnormalities, such as ascites, esophageal varices or a history of hepatic encephalopathy, that may indicate advanced liver dysfunction and/or presence of collateral circulation. These findings suggest that the occurrence of keto bile acids in the urine might be ascribed to the escape of these acids from reduction to hydroxy-forms in the liver, not to bacterial over-production in the intestine. However, the mechanism and significance of the presence of keto bile acids in the urine are still unknown.
通过气相色谱法和气相色谱-质谱联用分析法，对13例男性肝硬化患者的尿液和粪便胆汁酸进行分析，以获取有关其酮胆汁酸排泄的信息。在10例患者的尿液中发现了3α-羟基-12-酮-5β-胆烷酸、3α,12α-二羟基-7-酮-5β-胆烷酸、3α,7α-二羟基-12-酮-5β-胆烷酸和3α-羟基-7,12-二酮-5β-胆烷酸。在其中4例患者中，酮胆汁酸是尿液中排泄的主要胆汁酸。然而，这4例患者粪便中酮胆汁酸与粪便总胆汁酸的比值，与其他6例尿液中酮胆汁酸排泄量较低的患者相似。这4例患者中有3例存在临床异常情况，如腹水、食管静脉曲张或肝性脑病病史，这些可能表明存在晚期肝功能障碍和/或侧支循环。这些发现表明，尿液中酮胆汁酸的出现可能归因于这些酸在肝脏中未能还原为羟基形式而逸出，而非肠道细菌过度产生。然而，尿液中酮胆汁酸存在的机制和意义仍不清楚。
