| Objective:The purpose of this study is to explore the bile acid subtypes that can be used to identify the nature of gallbladder polypoid lesions by analyzing and comparing the contents of various bile acid subtypes in the serum of healthy people,patients with gallbladder stones and patients with gallbladder polypoid lesions,and to provide help for the diagnosis,treatment and prevention of gallbladder polypoid lesions in clinical practice.Methods:A retrospective study was used to collect the data from patients who visited the Dalian Municipal central hospital from December 2021 to June 2022.According to the basic clinical data of patients with gallstone disease or gallbladder polyps diagnosed by pathology after cholecystectomy in the department of hepatobiliary surgery in the hospital,they were divided into 32 cases of gallstone disease group,24cases of cholesterol polyps group and 20 cases of gallbladder adenoma group according to the pathological results after surgery,and a total of 19 cases of healthy human control group who were also scheduled for physical examination in our hospital were collected.The collected indicators include:(1)General information:general information such as the patient’s gender,age,BMI,personal history such as smoking,alcohol consumption,hypertension,coronary heart disease,and whether there has been medication use or surgery history in the past month;(2)Laboratory test indicators:total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)γ-Glutamatyltransferase(GGT),liver function indicators such as total protein and albumin,blood lipid indicators such as total cholesterol,coagulation related indicators such as prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),etc、the content of 15 bile acid subtypes in serum(Cholic acid,LCA、Deoxycholic acid,DCA、Goose deoxycholic acid,CDCA、Ursodeoxycholic acid,UDCA、Cholic acid,CA、Glycine cholic acid,GLCA、Glycidodeoxycholic acid,GDCA、Glycine goose deoxycholic acid,GCDCA、Glycourso deoxycholic acid,GUDCA、Giycine cholic acid,GCA、Calculus cholic acid,TLCA、Bezoar deoxycholic acid,TDCA、Cattle yellow goose deoxycholic acid,TCDCA、Bovine yellow bear deoxycholic acid,TUDCA、Bezoar cholic acid,TCA).SPSS26.0statistical software was used to analyze the collected data,and S-W normality test was carried out on the collected measurement data.The measurement data conforming to the normal distribution were tested by independent sample t test,and the measurement data not conforming to the normal distribution were tested by Kruskal-Wallis H test.If there were significant differences between multiple groups,Bonferoni test was used for comparison between two groups;The counting data were analyzed by x~2 test or Fisher’s exact test.After univariate analysis of the collected data,the receiver operating characteristic curve will be drawn for the bile acid subtypes with significant differences to determine the best cutoff value and evaluate the differential diagnostic efficacy of the different bile acid subtypes.The P value was considered to be statistically significant at5%level.Results:Statistical analysis of the collected subjects showed that there was no significant difference in the general clinical data of each group(P>0.05),which proved that the groups were comparable and could be further analyzed.In the univariate analysis of the laboratory test results of each group,it was found that there was no significant difference between the four groups in TBIL,ALT,AST,ALP,total protein,albumin,total cholesterol,PT,APTT,FIB,TT and other laboratory test indicators(P>0.05).The concentration ofγ-glutamyltransferase(GGT)was significantly different(P<0.05).The results of the comparison of the concentrations of various bile acid subtypes showed that there were significant differences among the four groups in the concentrations of glycine geese deoxycholic acid(GCDCA),glycine cholic acid(GCA)and taurine geese deoxycholic acid(TCDCA).There were significant differences between the two groups in the concentrations of GCDCA in the serum of patients with cholesterol polyps and gallbladder adenomas(P<0.05);The concentration of GCA was significantly different between gallbladder adenoma group and other groups(P<0.05);There was no statistically significant difference in other bile acid subtypes,such as lithocholic acid(LCA),deoxycholic acid(DCA),chenodeoxycholic acid(CDCA),ursodeoxycholic acid(UDCA),cholic acid(CA),glycine deoxycholic acid(GDCA),glycine ursodeoxycholic acid(GUDCA),taurine deoxycholic acid(TDCA)in each group(P>0.05).Through univariate analysis,it was found that GCDCA and GCA were different between cholesterol polyp group and gallbladder adenoma group.For cholesterol polyp and gallbladder adenoma,the receiver operating characteristic curve that included GCA and GCDCA were drawn.The best cutoff values of GCA and GCDCA were 2.21nmol/L and1.97nmol/L.The evaluation of their diagnostic efficacy found that when GCDCA≤1.97nmol/L was defined as cholesterol polyp,its specificity could reach 87.75%;When GCA≤2.21nmol/L or GCDCA≤1.97nmol/L is defined as cholesterol polyp,its sensitivity can reach 95.83%,and the negative predictive value is 90.91%;When GCA≤2.21nmol/L and GCDCA≤1.97nmol/L are defined as cholesterol polyps,the positive predictive value is 80.95%.Conclusion:There was no significant difference in GGT concentration between cholesterol polyp group and gallbladder adenoma group,and it could not be used as a marker to distinguish cholesterol polyp and gallbladder adenoma;The concentration of GCA and GCDCA in the serum of patients with cholesterol polyps is significantly lower than that of patients with gallbladder adenoma,and the sample acquisition is simple and minimally invasive,the patient’s economic burden is light,and the pain is small,which can initially be used as a pre-operative differential index.At the same time,the test of GCDCA is expected to become an early screening method for gallbladder adenoma and provide help for the secondary prevention of gallbladder adenoma in clinical practice. |
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