| Backgroud and objective: In recent years,The incident of glycolipid metabolic disorders in china,such as coronary heart disease,fatty liver,diabetes morbidity and mortality increased year by year.The elderly have become a high-risk population with the acceleration of the aging population.glycolipid metabolic disorders prevalence rate,mortality rate increased year by year,glycolipid metabolic disorders have become the first killer threat to the health of the elderly.At present,more researches and according to the changes of bile acid metabolism.Previous studies suggested that the determination of serum total bile acid is mainly used for the diagnosis of liver diseases,but recent studies indicated that many diseases such as fatty liver,hypertension,coronary heart disease,diabetes and other individual bile acids on glucose and lipid metabolism are changing.At home and abroad,The study of disorders lead to changes in levels of bile acids have been carried out like a raging fire.but most of the animal experiments,more researches for the changes of total bile acid level,The researches on human bile acid composition were seldom reported.Especily in elderly patients over the age of 80 years.This study measured the disease group compared with the healthy group,disease group atorvastatin before comparing elderly biochemical indexes and bile acids changes,clear bile acid changes and fatty liver,diabetes mellitus,coronary heart disease and the possible relationship between the effect of atorvastatin on bile acid.The effects of statins is hydroxyl amyl two acyl coenzyme A(HMG-COA)selective inhibitors of reductase,clinical as the preferred drug for treating hyperlipemia and mechanism of atorvastatin on liver injury induced by cholestasis may inhibit bile saltsand bile acid excretion related Activity induced by transporters.Clinical application of atorvastatin can cause bile acid deposition,thus changing the bile acid metabolism.Serum bile acids may be lipid metabolism disorders in elderly intervention targets and indicators,the accumulation of more clinical basis for senile lipid metabolic disorder disease.Which is beneficial to the clinical diagnosis and treatment of patients,improve the prognosis and quality of life of elderly patients.Methods: This topic through the screening of the August 2016 to January 2017 in Dalian Medical University hospital cadre ward 210 hospital and the First Affiliated Hospital of Dalian PLA Hospital treatment,age 80-95 years old,according to the inclusion and exclusion criteria,in accordance with the standards of the elderly patients with a total of 50 cases.According to the 1999 WHO diagnostic criteria for diabetes,history of Chinese Medical Association diagnostic criteria of coronary heart disease liver disease Branch Sixth Edition 2015 fatty liver clinical diagnosis and medicine with infarction or coronary angiography with myocardial coronary atherosclerotic plaque formation(stenosis 50%)As the diagnostic criteria,will meet the inclusion criteria were divided into healthy control group(10 cases),fatty liver group(13 cases))and diabetes group(15 cases)),coronary heart disease group(12cases),patients were selected for oral Atorvastatin Calcium Tablets 20 mg,1/ late,21 days.All of the subjects were measured before and after treatment in biochemistry,serum etiology tests.By using high performance liquid chromatography tandem mass spectrometry(High performance liquid chromatography tandem mass spectrometry,HP LC-MS/MS)quantitative detection of serum fasting were 13 kinds of bile acid content.13 bile acids were: cholic acid(Cholic acid,CA(Lithocholic),lithocholic acid acid,LCA),deoxycholic acid(Deoxycholate,DCA),deoxycholic acid(Chenodeoxycholate,CDCA),ursodeoxycholic acid(Ursodeoxycholic,acid,UDCA),cholylglycine(Glycocholic acid hydrate,GCA),Gly goose deoxycholic acid(Gan Hong de Oxycholate,GCDCA))and glycodeoxycholate(Ursodeoxycholic acid,GDCA),taurolithocholate(Taurolithocholate,TLCA),sodium deoxycholic acid(Taurochenodeoxycholate,TCDCA),Taurocholic acid(Taurodeoxycholate,hydrate,TDCA),deoxycholic acid(Tauroursodeoxycholate,TUDCA),(Taurocholic acid hydrate,taurocholic acid TCA).All experimental data were input SPSS18.0 statistical software for analysis using Shapiro-Wilk normality test data.The normal distribution of data using the mean and standard deviation(x + s)said that the non normal distribution of measurement data using the median(four percentile interval).In accord with normal distribution the data using the t test or analysis of variance(one-way ANOVA)statistics,which does not conform to the normal distribution of the data using the Mann-Whitney Test test,the classification of test data using X2.P < 0.05 was statistically significant,with P < 0.01 indicating significant difference.Correlation analysis was performed using Spearman nonparametric correlation analysis.Result:1.Fatty liver groups before treatment compared with the control group,serum GCA,GDCA,GCDCA,TCA,TCDCA,TLCA levels were significantly increased(P< 0.05);fatty liver after treatment compared with before treatment,serum CA,CDCA,GCA,GCDCA,UDCA increased,TCA decreased(P < 0.05).2.Compared with the control group,diabetic group before treatment serum CA,UDCA were significantly increased(P < 0.01),GDCA,GCDCA,TCA,TCDCA,TLCA level(P < 0.05);LCA,TUDCA decreased(P < 0.05);diabetes group after treatment compared with before treatment,serum CA,CDCA,UDCA that elevated levels of LCA(P < 0.05),in which CA,significant changes in CDCA(P < 0.01).3.Coronary heart disease group before treatment compared with the control group,serum CA,CDCA,DCA,LCA,TCA levels were significantly increased(P <0.01);the level of TLCA decreased(P < 0.05);coronary heart disease group after treatment compared with before treatment,UDCA,TDCA,TUDCA,TLDCA level,TUDCA,significant changes(TLDCA P < 0.01);LCA,TCA were significantly decreased(P < 0.01).4.Compared with the control group,the level of serum conjugated bile acids increased significantly(P < 0.01)in the fatty liver group,but the free bile acidsincreased significantly(P < 0.01),and the conjugated bile acids decreased significantly(P < 0.01);Compared with the control group,the conjugated bile acids increased(P < 0.05)before the administration of diabetes,and the free bile acids increased(P < 0.01)before the treatment,but the conjugated bile acids decreased(P <0.05);Compared with the control group,the free bile acid increased(P < 0.05)before the medication in the coronary heart disease group,and there was no statistical significance before and after the treatment.5.In the fatty liver group,compared with the control group,CA/CDCA decreased significantly(P < 0.01),and GCA/TCA decreased(P < 0.05).Compared with the pre medication,the GCA/TCA increased significantly(P < 0.01),and the CA/CDCA increased(P < 0.05);6.Analysis of biochemical indexes and bile acid levels for correlation between disease group before and after treatment,suggesting that CA(r=0.376,P=0.040),GCA(r=0.476,P=0.021)were positively correlated with the LDL level before treatment.Analysis of TBA was negatively correlated with serum cholinesterase(r=-0.653,P=0.019),and serum GCA(r=-0.391,P=0.035)and TCA(r=-0.327,P=0.028)levels were negatively correlated with serum cholinesterase levels.The serum bile acid levels of after treatment,There was no correlation with blood lipid level and liver function.Conclusion:1.Serum total bile acid levels in fatty liver,diabetes,coronary heart disease have changed and bile acids spectrum in serum also changed,atorvastatin calcium does not affect the change of serum total bile acid levels,but it can cause the change of serum bile acid subgroups,glucose and lipid metabolism disorders in elderly with bile acids close relationship.2.Conjugated bile acids increased when glucose and lipid metabolic disorder of serum bile acids in the elderly,of which glycine conjugated increased significantly.The serum conjugated bile acid was significantly increased in patients with fatty liver.These subtypes of bile acids may be transformed into each other in glucose and lipid metabolism disorders patients. |
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