Correlation Between Peripheral Blood Bile Acid And Gastric Cancer:a Retrospecitve Controlled Study

Background:Gastric cancer(GC)is a common malignant tumor,which develops through chronic superficial gastritis,chronic atrophic gastritis,intestinal metaplasia(IM),dysplasia and then to GC.Risk factors for GC include demographics,environment,diet,infection,and genetics.In addition,a large number of studies have shown that gastric bile acids increase the degree of gastric mucosal injury,induce intestinal metaplasia of the gastric mucosa,and increase the risk of GC.However,the relationship between Total bile acid(TBA)levels and GC is not clear.Objective:To investigate the relationship between the level of TBA and GC,determine whether TBA is an independent risk factor for GC,and provide new ideas for GC prevention.Method:This study is a retrospective controlled study.In the case group:patients with GC who underwent surgical resection and were pathologically diagnosed at Xijing Hospital on January 1,2015 were included.In the control group,non-GC patients hospitalized during the same period who met the inclusion and exclusion criteria were selected.A total of 1280 GC patients and 1594 non-GC patients who met the inclusion and exclusion criteria were collected.Information of data collected included: name,gender,age,ethnicity,blood type,body mass index(BMI)and other general information;serum bile acid(TBA),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),glucose(GLU),γ-glutamyltransferase(GGT),uric acid(UA),alkaline phosphatase(ALP),total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL),low-density lipoprotein(LDL),tumor markers(CEA,CA199,CA125,CA724,AFP)and other serological information;Helicobacter pylori(H.pylori)infection;past medical history such as history of biliary tract disease(gallstones,gallbladder polyps),history of cholecystectomy,history of appendectomy,history of GC in a first-degree relative,history of diabetes,history of coronary heart disease,history of thyroid disease(hyperthyroidism,hypothyroidism),history of hypertension;history of oral medication: metformin,antihypertensive drugs,aspirin,clopidogrel,statins.For the case group,the site of tumorigenesis and TNM stage were additionally collected.Data analysis: t test,non-parametric test,X~2 test and binary logistic regression analysis were used(P<0.05 indicated statistical significance),and life table method was used for survival analysis.Results:(1)The TBA level of the GC group was higher than that in the non-GC group,and the difference was statistically significant(P<0.05);the GLU,ALP,CEA,AFP,CA199,and CA125 levels in the GC group were higher than those in the non-GC group,and the level of CA724 was higher than that in the non-GC group,and the difference was not statistically significant(P>0.05);the levels of ALT,AST,TBIL,DBIL,GGT,UA,TC,TG,and LDL in the non-GC group were higher than those in the GC group,and the difference was statistically significant(P<0.05);and the levels of IBIL and HDL were higher than those in the GC group,and the difference was not statistically significant(P>0.05).(2)The univariate analysis showed that male gender,age 56-57 years,rural residence,Han nationality,blood type A,occupation mainly manual labor,family history of GC,history of diabetes,history of cholecystectomy,aspirin,metformin,TBA greater than 15 umol/L,ALP greater than 74 IU/L,GLU greater than 5.21 mmol/l,CEA greater than 1.95 ng/ml,AFP greater than 2.74 ng/ml,CA199 greater than 9.43 U/ml,and CA125 greater than 9.66 U/ml were all risk factors for GC.(3)The multivariate analysis showed that male gender,age greater than 56 years,occupation mainly manual labor,rural residence,history of cholecystectomy,history of diabetes,aspirin,TBA greater than 15 umol/L,ALP greater than74 IU/L,GLU greater than 5.21 mmol/L,CEA greater than 1.95 ng/m L,AFP greater than2.74 ng/m L,and CA125 greater than 9.66 U/m L were independent risk factors for GC,while taking antihypertensive drugs was negatively correlated with the risk of GC.(4)The TBA levels of GC varied at different sites,and the TBA level of distal gastric cancer is the highest.(5)TBA level in GC patients were not associated with patients survival.Conclusion: The level of TBA in the GC group was higher than that in the non-GC group,and both univariate analysis and multivariate analysis indicated that elevated TBA level was one of the risk factors for GC.Attention should be paid to the prevention and screening of GC for patients with elevated TBA.