2024 年第 6 期 第 0 卷

术前血清胆汁酸水平与结直肠癌患者临床指标及预后的关系

The relationship between preoperative serum bile acid levels and clinical indicators and prognosis of patients with colorectal cancer

作者：石濮菘1于丽1刘学焕2高卫峰3刘筠4

英文作者：Shi Pusong1 Yu Li1 Liu Xuehuan2 Gao Weifeng3 Liu Jun4

单位：1天津中医药大学研究生院，天津301617；2天津市人民医院放射科，天津300122；3天津市人民医院肛肠外科，天津300122；4天津市第四中心医院放射科，天津300140 通信作者：刘筠，Email：cjr.liujun@vip.163.com

英文单位：1Graduate School of Tianjin University of Traditional Chinese Medicine Tianjin 301617 China; 2Department of Radiology Tianjin Union Medical Center Tianjin 300122 China; 3Department of Colorectal Surgery Tianjin Union Medical Center Tianjin 300122 China; 4Department of Radiology Tianjin 4th Central Hospital Tianjin 300140 China

关键词：结直肠癌；胆汁酸类；危险因素；预后

英文关键词：Colorectalcancer;Bileacid;Riskfactors;Prognosis

• 摘要：

• 目的 探究结直肠癌患者手术治疗前血清胆汁酸水平与临床指标及预后的相关性。方法 收集2018年1月至2022年8月就诊于天津市人民医院并明确诊断为结直肠癌的253例患者作为观察组。收集同期248例未合并其他重大疾病混合痔患者作为对照组进行回顾研究。根据上述患者临床资料，采用Logistic回归方法分析结直肠癌发生的影响因素；比较手术治疗前后血清胆汁酸水平变化；Spearman法分析术前血清胆汁酸水平与肿瘤标志物、淋巴细胞亚群、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）等指标的相关性；Kaplan-Meier 法绘制生存曲线，比较不同血清胆汁酸水平患者的预后差异；比较不同血清胆汁酸水平患者在病变部位与病理方面的差异。结果 Logistic回归分析显示较高的血清胆汁酸水平为结直肠癌的危险因素（比值比=1.102，95%置信区间：1.022～1.189，P=0.012）；术后血清胆汁酸水平低于术前（P＜0.05）。术前血清胆汁酸水平与癌胚抗原、IL-6、TNF-α水平呈正相关（均P＜0.05）。生存分析提示血清胆汁酸高水平（≥4.7 μmol/L）患者较低水平（<4.7 μmol/L）患者无复发生存时间短（Log-rank χ2=9.711，P=0.002），复发转移率高［55.6%（15/27）比25.8%（17/66）］（P＜0.05）；血清胆汁酸高水平组低中分化比例高于、病变部位在右半结肠的比例低于血清胆汁酸低水平组（均P＜0.05）。结论 术前高水平的血清胆汁酸是结直肠癌发生的危险因素，与部分肿瘤标志物、炎症因子呈正相关，且与肿瘤病变部位、病理及患者预后有关，在指导结直肠癌患者临床诊疗中存在一定价值。

• Objective To investigate the correlation between preoperative serum bile acid level and clinical indicators and prognosis in patients with colorectal cancer. Methods A total of 253 patients diagnosed with colorectal cancer in Tianjin Union Medical Center from January 2018 to August 2022 were collected as the observation group. During the same period, 248 cases of mixed hemorrhoids without other serious diseases were collected as the control group for retrospective study. According to the clinical data of these patients, Logistic regression method was used to analyze the influencing factors of colorectal cancer occurrence. The changes of serum bile acid levels before and after surgery were compared. Spearman correlation analysis was used to analyze the correlation between preoperative serum bile acid level and tumor markers, lymphocyte subsets, interleukin-6 (IL-6), as well as tumor necrosis factor α (TNF-α). The Kaplan-Meier method was used to draw survival curves and compare the prognostic differences of patients with different levels of serum bile acid. The differences of lesion location and pathology in patients with different serum bile acid levels were compared. Results Logistic regression analysis showed that higher serum bile acid level was a risk factor for colorectal cancer(odds ratio=1.102, 95% confidence interval: 1.022-1.189, P=0.012). The postoperative serum bile acid level was lower than that before operation (P < 0.05). The preoperative serum bile acid levels were positively correlated with carcinoembryonic antigen, IL-6, and TNF-α levels (all P<0.05). Survival analysis showed that patients with higher levels （≥4.7 μmol/L） of serum bile acid had shorter recurrence free survival time than those with lower levels （<4.7 μmol/L）(Log-rank χ2=9.711, P=0.002), recurrence and metastasis rate was higher ［55.6%(15/27) vs 25.8%(17/66)］(P<0.05). The proportion of low and moderate differentiation was higher and the proportion of lesions located in the right colon was lower in the high level of serum bile acid group than those in the low level of serum bile acid group (all P<0.05). Conclusions  Preoperative high level of serum bile acid is a risk factor for colorectal cancer, which is positively correlated with some tumor markers and inflammatory factors, and is related to tumor location, pathology and prognosis of patients. It has certain value in guiding the clinical diagnosis and treatment of patients with colorectal cancer.