Risk Factors Of PSC And Clinical Significance Of Changes In Serum Bile Acid And Biliary Microflora

Objective: To explore the changes and correlation of serum total bile acid levels and biliary tract flora in patients with primary sclerosing cholangitis(PSC),and their impact on the onset and severity of disease in PSC patients,with a view to finding effective new measures for early diagnosis and intervention,and providing relevant theoretical basis for the prevention and treatment of PSC.Methods: From October 2020 to January 2023,the inpatients were diagnosed and treated in the Department of dispelling Medicine and Department of Hepatobiliary surgery of the affiliated Hospital of Youjiang Medical University For Nationalities,and were considered as PSC by B-ultrasound and / or magnetic resonance imaging(MRI)and magnetic resonance cholangiopancreatography MRCP).Fourteen patients with PSC treated by endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic nasobiliary drainage(ENBD)were successfully treated,and 17 patients with PSC were excluded as control group.The general data of the two groups: age,sex,personal history,past history,family history,etc,were collected to determine the liver function of the two groups: total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),serum total bile acid(TBA),alkaline phosphatase(ALP),gamma-glutamyl-transpeptidase(GGT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),the antinuclear antibody and antinuclear antibody profiles of the two groups were measured.The antinuclear antibody profiles included: anti ribonucleoprotein antibodies,anti Sm antibodies,anti SS-A antibodies,anti Ro-52 antibodies,anti SS-B antibodies,anti Scl-70 antibodies,anti JO-1 antibodies,anti centromere B antibodies,anti double stranded DNA antibodies,anti nucleosome antibodies,anti histone antibodies,and anti ribosome P protein antibodies.Bile was taken for bacterial culture,and the difference of liver function and bile culture results between the two groups,as well as the correlation between each index were analyzed.Results: 1.The average age of PSC patients was(53.43 ± 14.50)years old,and the ratio of male and female patients was 4:3;The average age of patients in the control group was(50.82 ± 13.49)years old,and the ratio of male and female patients was 9:8.There was no significant difference in age and sex between PSC group and control group(P>0.05).Compared with the control group,patients in the PSC group were more likely to have jaundice,pruritus and yellow urine(P<0.05).2.The positive rate of autoimmune body in PSC patients was higher than that in the control group,and the difference was statistically significant(P<0.05).3.Compared with the control group,TBIL,DBIL,IBIL,TBA,ALP,GGT,ALT and AST were significantly higher(P<0.05).4.Logistic regression analysis results show that TBA,ALP,GGT,ALT and AST are independent risk factors affecting PSC patients.5.The results of Spearman correlation analysis showed that TBA in PSC group was positively correlated with TBIL,DBIL,ALT and AST,and the difference was statistically significant(all P<0.05);There was no significant correlation between other indicators and TBA(all P>0.05).6.Serum TBA,ALP,GGT,ALT,AST levels have certain diagnostic efficacy for PSC.7.The positive rates of bile culture in PSC group and control group were 33.3% and 56.3%respectively.Escherichia coli and Enterococcus faecalis are the main bacteria in the bile of PSC patients.Conclusion: 1.The serum TBA level of PSC patients was higher than that of non PSC patients;2.TBA,ALP,GGT,ALT and AST are independent risk factors for the onset of PSC;3.The serum TBA level of PSC patients is positively correlated with TBIL,DBIL,ALT and AST levels.The more TBA content in serum is,the more TBIL,DBIL,ALT and AST content is.The serum TBA level is helpful to predict the occurrence of PSC disease and evaluate the disease progress and prognosis;4.The positive rate of biliary bacteria culture in PSC group was low,and the abundance of bacteria was low.Escherichia coli might be resident bacteria in the biliary tract of PSC patients,affecting the colonization of probiotics in the biliary tract.