Establishment of the chemical diagnosis in intestinal diseases with serum bile acid determination

未结合胆汁酸(F)或脱氧胆酸(DC)在某些胃肠道疾病中可见细菌过度生长。口服UDCA负荷试验有助于胆汁酸吸收不良的诊断。因此，为了了解消化道疾病发病机制的生化信息，我们尝试结合血清胆汁酸谱测定和口服UDCA负荷试验来区分细菌过度生长和胆汁酸吸收不良。[对象和方法]采用高效液相色谱法测定50例各种胃肠道疾病患者和12例正常对照的血清胆汁酸水平。我们对16例肠道疾病患者进行了口服300 mg UDCA负荷试验。血清总胆汁酸测定采用酶荧光法。[结果]1)与正常对照组比较，52例各种胃肠道疾病患者中有23例F细胞比例增加，16例DC细胞比例增加。术中采集的肠液中的F和血清中的F均显著升高。2)16例肠道疾病患者中，10例经口UDCA负荷试验显示外源性UDCA较正常对照组显著降低。3)14例肠道疾病患者结合口服UDCA负荷试验和血清单个胆汁酸测定，可将其分为4型：I型；异常组(F或DC增高)，II型；血清胆汁酸清除曲线平坦型，III型；异常型和平坦型，IV型；

The increase of unconjugated bile acid (F) or deoxycholic acid (DC) occurred in some gastrointestinal diseases with bacterial overgrowth. The oral UDCA loading test was useful in diagnosing the bile acid malabsorption. Therefore, in order to know the biochemical information of the pathogenesis in the alimentary tract , we tried to distinguish bacterial overgrowth from bile acid malabsorption by combining the determination of serum bile acid profile and oral UDCA loading tests. [Subjects and Methods ] We measured serum bile acid profile in 50 cases with various gastrointestinal disorders and 12 normal controls by HPLC with 3alpha-HSD immobilized column. We performed oral 300mg of UDCA loading test in 16 cases with intestinal diseases. Total serum bile acid was measured by enzymatic fluorometrically. [Results] 1) In 23 out of 52 cases with various gastrointestinal diseases, the percentage of F increased, and in 16 out of 52 cases, DC increased, compared with the one in normal controls. F in the intestinal fluid collected during surgery, increased remarkably as well as the one in serum. 2) In 10 out of 16 cases with intestinal diseases , oral UDCA loading test revealed a significant decrease of exogeneous UDCA compared with the one in normal controls. 3) Using the combination of the oral UDCA loading test and the measurement of serum individual bile acid in 14 cases with intestinal diseases, these could be classified into 4 types as follows ; Type I ; abnormal profile group ( increased F or DC), Type II ; flattened serum bile acid clearance curve, Type III ; both abnormal profile and flattened curve, Type IV ; normal group [Conclusion] The bacterial overgrowth and bile acid malabsorption could be differentiated with using the combination of the measurement of serum bile acid profile and the oral UDCA loading test.