Abstract:

Objective　To detect the level of fecal primary and secondary bile acids in infants with infantile cholestatic hepatopathy（ICH）and analyze its clinical value. Methods　Thirty infants with ICH were enrolled in this study，who were diagnosed with infantile cholestatic hepatopathy. Thirty infants with good health condition were enrolled as the healthy control group. The fecal samples were collected respectively in the preparatory treatment phase and treatment phase from infants with ICH and from the healthy infants. Bile acids were extracted from infants’ feces and were quantitatively analyzed by liquid chromatography-mass spectroscopy. Results　Among the fecal primary bile acids，the level of cholic acid，chenodeoxycholic and glycochenodeoxycholic acid both in the ICH preparatory treatment group and ICH treatment group was significantly lower than that in the healthy control group（P＜0.016）.The level of fecal cholic acid and chenodeoxycholic acid of ICH treatment group was higher than in the ICH preparatory treatment group（P＜0.016）. Among the fecal secondary bile acids，the level of lithocholic acid both in the ICH preparatory treatment group and ICH treatment group was significantly lower than that in the healthy control group（P＜0.016），and the level of ursodeoxycholic acid in the ICH preparatory treatment group was lower than that in the ICH treatment group and healthy control group（P＜0.016）. Conclusion　In infants with ICH, the changes of fecal primary bile acids and fecal secondary bile acids have their own characteristics at the early stage of treatment, which may be caused by the short-term treatment, the prognosis of the disease itself and the changes of intestinal function, including intestinal bacteria. Clinical attention should be paid to these changes.

Key words: cholestatic hepatopathy, infant, feces, primary bile acid, secondary bile acid, intestinal bacteria

摘要：

目的    探讨婴儿胆汁淤积性肝病（infantile cholestatic hepatopathy，ICH）患儿粪便中初级和次级胆汁酸含量变化及其临床意义。方法　选取2014年11月至2015年11月在昆明医科大学第一附属医院儿科及昆明医科大学附属儿童医院消化内科住院诊断ICH患儿30例，选取同期来院体检的健康婴儿30例为对照组。收集ICH组治疗前、治疗后和正常对照组的粪便标本。应用液相色谱-质谱联用法定量测定各组婴儿粪便中初级胆汁酸及次级胆汁酸含量。结果　粪便初级胆汁酸中，ICH治疗前组及治疗后组胆酸、鹅去氧胆酸及甘氨鹅去氧胆酸含量均低于正常对照组，差异有统计学意义（P＜0.016）。治疗后组粪便胆酸及鹅去氧胆酸高于治疗前组，差异有统计学意义（P＜0.016）。粪便次级胆汁酸中，ICH治疗前组及治疗后组石胆酸含量均低于正常对照组；治疗前组熊去氧胆酸含量低于正常对照组及治疗后组，差异有统计学意义（P均＜0.016）。结论　ICH患儿治疗初期粪便中初次级胆汁酸的变化有其特点，可能为治疗时间短、疾病本身转归以及肠道功能包括菌群改变导致，临床须引起重视。

关键词: 胆汁淤积性肝病, 婴儿, 粪便, 初级胆汁酸, 次级胆汁酸, 肠道菌群