Clinical Significance Of Peripheral Blood Bile Acid Detection In Identifying The Nature Of Gallbladder Polypoid Lesions

Objective:Polypoid Lesions of Gallbladder(PLG)can be divided into neoplastic polyps such as adenomatous polyps and adenocarcinoma and non-neoplastic polyps such as cholesterol polyps and inflammatory polyps.Adenomatous polyps in neoplastic polyps are mostly suggestive of precancerous lesions and require surgical treatment.Non-neoplastic polyps,the most common is cholesterol polyps,have no malignant tendency and do not require surgical treatment.In this study,by analyzing the concentration differences of 15 bile acids in serum between subjects with cholesterol polyps and adenomatous polyps and between cholesterol polyps and gallbladder stones,the differences of bile acids in serum between cholesterol polyps and gallbladder stones and the preoperative metabolic differential diagnosis markers of cholesterol polyps and adenomatous polyps were explored,so as to improve the accuracy of surgeons ’ choice of PLG surgery.It can not only avoid unnecessary cholecystectomy in patients,but also avoid a few patients missing the best treatment opportunity for precancerous lesions or gallbladder cancer because of not timely cholecystectomy,and achieve greater economic and social benefits.Methods:In this study,we selected a total of 80 subjects from the Department of Hepatobiliary and Pancreatic Surgery of Hunnan District,the First Affiliated Hospital of China Medical University.They were divided into 4 groups:cholesterol polyps group,adenomatous polyps group,,gallbladder stones group,and blank control group,20 people in each group.We use the Ultra High Performance Liquid Chromatography-Mass Spectrometry Tandem Analysis System(UPLC-MS/MS)to detect the differential expression of 15 bile acids including conjugated bile acids and free bile acids in peripheral venous blood of patients with cholesterol polyps,adenomatous polyps and gallbladder stones.Results:The concentrations of glycocholic acid(GLCA),deoxycholic acid(DCA)and glycodeoxycholic acid(GDCA)in cholesterol polyp group,adenomatous polyp group,gallbladder stone group and blank control group were different,and the difference was statistically significant(P<0.05).The concentration of glycocholic acid(GLCA)in the cholesterol polyp group was significantly lower than that in the adenomatous polyp group and the control group(H=30.53,P<0.001).H=24.35,P=0.006);The concentration of deoxycholic acid(DCA)in cholesterol polyp group was significantly lower than that in adenomatous polyp group and control group(H=28.75,P=0.001;h=24.85,P=0.004);The concentration of glycine deoxycholic acid(GDCA)in cholesterol polyps group was significantly lower than that in adenomatous polyps group and control group(H=26.35,P=0.002;H=31.55,P<0.001);There was no significant difference in the expression of 15 bile acids between adenomatous polyp group and control group(P>0.05).There was no significant difference in the expression of 15 bile acids between the cholesterol polyps group and the gallbladder stone group(P>0.05).Conclusion:The concentrations of GLCA,DCA and GDCA in the cholesterol polyp group were significantly lower than those in the adenomatous polyp group,which may be used as preoperative differential diagnostic markers for adenomatous polyps and cholesterol polyps.The diagnostic sensitivity of GLCA combined with DCA is higher,which can reduce the missed diagnosis rate of adenomatous polyps.The diagnostic specificity of GLCA combined with DCA is higher,which can reduce the misdiagnosis rate of adenomatous polyps and improve the diagnostic rate of adenomatous polyps.