Azer S A, Coverdale S A, Byth K, Farrell G C, Stacey N H
Toxicology Unit, National Institute of Occupational Health and Safety, Sydney, Australia.
J Gastroenterol Hepatol. 1996 Mar;11(3):208-15. doi: 10.1111/j.1440-1746.1996.tb00064.x.
In order to determine the value of serum bile acids in predicting the course of chronic cholestatic liver diseases, we measured individual serum bile acids serially, using high-performance liquid chromatography, over a 4 year observation period in 12 patients with primary biliary cirrhosis and six patients with primary sclerosing cholangitis. The changes in individual serum bile acids and the ratios thereof, conventional liver tests and Child-Turcotte and Mayo scores were compared between survivors (n = 10) and patients who underwent liver transplantation for (n = 3) or died of the liver disease (n = 5). Patients with a serum total chenodeoxycholic acid concentration at study entry that exceded 15 mumol/L were 10 times more likely to die or need a liver transplant in the following 4 years than those with chenodeoxycholic acid levels < 15 mumol/L (P < 0.05). None of the other biochemical parameters or clinicopathological scores could similarly discriminate between the two groups at entry. Time-dependent analyses for the cholic acid/chenodeoxycholic acid ratio, serum total bilirubin and albumin concentrations and Child-Turcotte and Mayo scores were able to differentiate between primary sclerosing cholangitis patients who died or were transplanted and those who were not, whereas age of the patients and other parameters did not. The taurocholic acid/taurochenodeoxycholic acid ratio fell during progression of primary biliary cirrhosis but rose in temporal relationship with primary sclerosing cholangitis. This differential pattern of change was unique compared with other clinical and laboratory indices. In conclusion, serum chenodeoxycholic acid levels and the cholic acid/chenodeoxycholic acid ratio in both diseases were independent indices that allowed for the prediction of survival or the need for liver transplantation. These indices are worthy of further examination in a larger group of patients as prognostic criteria for chronic cholestatic liver disease and in the assessment of the efficacy of therapeutic interventions, including liver transplantations.
为了确定血清胆汁酸在预测慢性胆汁淤积性肝病病程中的价值，我们在4年的观察期内，使用高效液相色谱法对12例原发性胆汁性肝硬化患者和6例原发性硬化性胆管炎患者的血清胆汁酸进行了连续测定。比较了存活者（n = 10）与接受肝移植（n = 3）或死于肝病（n = 5）患者的个体血清胆汁酸及其比值变化、传统肝功能检查以及Child-Turcotte和Mayo评分。研究开始时血清鹅去氧胆酸总浓度超过15 μmol/L的患者在接下来4年中死亡或需要肝移植的可能性是鹅去氧胆酸水平< 15 μmol/L患者的10倍（P < 0.05）。其他生化参数或临床病理评分在研究开始时均无法同样区分这两组患者。对胆酸/鹅去氧胆酸比值、血清总胆红素和白蛋白浓度以及Child-Turcotte和Mayo评分进行的时间依赖性分析能够区分原发性硬化性胆管炎中死亡或接受移植的患者与未死亡或未接受移植的患者，而患者年龄和其他参数则不能。在原发性胆汁性肝硬化进展过程中，牛磺胆酸/牛磺鹅去氧胆酸比值下降，但在原发性硬化性胆管炎中呈时间相关性上升。与其他临床和实验室指标相比，这种变化的差异模式是独特的。总之，两种疾病中的血清鹅去氧胆酸水平和胆酸/鹅去氧胆酸比值是独立的指标，可用于预测生存或肝移植需求。作为慢性胆汁淤积性肝病的预后标准以及在评估包括肝移植在内的治疗干预效果时，这些指标值得在更大规模的患者群体中进一步研究。
