Value Of Serum Bile Acid Spectrum In Diagnosis Of Biliary Atresia

Objectives:Bile acid is the main component of bile,which can participate in the synthesis,transport and metabolism of bile.Studies have found that bile acids are associated with a variety of hepatobiliary diseases,but there are few studies on bile acids and biliary atresia(BA)diseases.Therefore,the first part of this study aims to explore the correlation between bile acids and BA diseases.The prognosis of children with BA is closely related to the age at the time of surgery.Early diagnosis and early surgery can reduce complications and improve autologous liver survival.At present,it is difficult to distinguish BA from other biliary tract obstruction diseases early in clinical practice,which causes BA children to be older at the time of surgery and the prognosis is poor.In recent years,it has been reported that bile acids can be used for the diagnosis of BA diseases,so the second part of this study aims to explore the value of bile acid spectrum in early diagnosis of BA diseases.Through this study,preoperative serum bile acids were detected in children with biliary obstruction,looking for sensitive indicators for diagnosis of BA,providing new methods and directions for early identification of BA,helping clinicians to achieve early diagnosis,early surgery,and increase the rate of yellowing to reduce the probability of liver transplantation and improve the prognosis of children.Methods:Fifty children with biliary obstruction aged less than 3 months who were hospitalized for neonatal surgery at the children’s hospital of Xi’an from January 2018 to May 2019 were collected as the study subjects,and included in the case group.All 50 children underwent biliary angiography during surgery.The diagnosis was confirmed,and the patients were divided into the atresia group(27 cases)and the silt group(23 cases)according to the angiography results.The patients with no jaundice,no infection,and less than 3 months of age who were treated in the neonatal surgery hospital of our hospital were selected as the control group(34 cases).Ultrasound liquid chromatography-tandem mass spectrometry(LC-MS/MS)was used to detect the serum bile acid levels of the three groups of children before surgery.15 serum bile acid spectra were compared between each group,and primary combined bile acid and differences in primary free bile acid ratio levels were determined using the ROC curve to determine the best cutoff value for statistically significant differences between the atresia group and the silt group,and the value of diagnosing BA was analyzed.Results:1)Retrospective analysis was performed on 15 types of serum bile acid profiles and the ratio of primary combined bile acid to primary free bile acid in the locked group and the silt group.The analysis found that the levels of glycine bile acid(GCA)and glycine bile acid/chenodeoxycholic acid(GCA/CDCA)were significantly higher than those in the silt group,the difference was statistically significant(p<0.05),and the remaining bile acids were not significantly different(P>0.05).2)According to the ROC curves of GCA and GCA/CDCA in the atresia group and the silt group,the best cutoff values for the diagnosis of BA by the two are 21umol/L and 846,respectively.At this time,the sensitivity and specificity corresponding to GCA were 88.9%and 56.5%;while the sensitivity and specificity corresponding to GCA/CDCA were 51.9%and 91.3%.3)The area under the ROC curve(AUC)of GCA and GCA/CDCA in the atresia group and the silt group was analyzed.The analysis found that the best cutoff value for single GCA and GCA/CDCA was 0.725 and 0.694 for the diagnosis of BA,respectively.The AUC was 0.731 at the time of combined diagnosis.There was no significant difference between the GCA or GCA/CDCA and the AUC of the two combined diagnosis of BA(P>0.05).4)Analyze and study 15 types of serum bile acid spectrum and ratio of primary combined bile acid to primary free bile acid in atresia group and normal group,silt group and normal group.LCA、DCA、UDCA、glycine cholic acid/cholic acid(GCA/CA)、taurocholic acid/cholic acid(TCA/CA)were not significantly different from those in the atresia group and the stasis group(P>0.05).There was a statistical difference(P<0.05).Except for chenodeoxycholic acid(CDCA),which was significantly higher in the normal group than in the atresia group and the silt group,the rest were significantly higher in the atresia group and the silt group than the normal group.Conclusions:1)Glycocholic acid(GCA),Glycocholic acid/Chenodeoxycholic acid(GCA/CDCA)in serum bile acids can distinguish BA and other non-BA biliary obstruction diseases.Among them,preoperative serum when GCA>21umol/L or GCA/CDCA> 846,BA is highly likely,which can be used as a basis for early diagnosis of BA.2)Preoperative serum GCA and GCA/CDCA combined diagnosis of BA in children with biliary obstruction has no advantage over single index.The diagnostic value of GCA is higher than that of GCA/CDCA,so GCA>21umol/L is more suitable as a basis for serum bile acid spectrum diagnosis of BA.3)Except for secondary free bile acids,glycine cholic acid/cholic acid(GCA/CA)and taurocholic acid/cholic acid(TCA/CA),other serum bile acids can be used as the basis for diagnosing bile duct obstruction diseases.Among them,when chenodeoxycholic acid(CDCA)is significantly reduced,or other bile acid is significantly increased,it is highly suggestive of biliary obstruction disease.