使用血清7-α-C4和48小时粪便胆汁酸诊断胆汁酸吸收不良（BAM）的真实世界经验。

Real-world experience with the diagnosis of bile acid malabsorption (BAM) using serum 7-alpha-C4 and 48-hour stool bile acids.

作者信息

Mendoza-Domínguez G, Garrido-Santos Z M, Lau C, Balbuena R, Santana-Vargas A D, Schmulson-Wasserman M

机构信息

Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Investigación en Medicina Experimental (UME) Dr. Ruy Pérez Tamayo, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico; Programa de Estudios Combinados en Medicina (PECEM), Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.

Laboratorios Biomédica de Referencia, Mexico City, Mexico.

出版信息

Rev Gastroenterol Mex (Engl Ed). 2025 Apr-Jun;90(2):169-175. doi: 10.1016/j.rgmxen.2025.05.002. Epub 2025 May 17.

DOI:10.1016/j.rgmxen.2025.05.002

PMID:40383704

Abstract

INTRODUCTION AND AIMS

Bile acid malabsorption (BAM) is responsible for 30% of cases of diarrhea-predominant irritable bowel syndrome (IBS-D) or functional diarrhea and 63.5% of cases of diarrhea following cholecystectomy. SeHCAT is the gold standard diagnostic method but is unavailable in Mexico. Alternatively, primary bile acid (PBA) and total bile acid (TBA) determination in 48 h stools and 7αC4 measurement have been proposed as screening tests.

OBJECTIVE

Our aim was to evaluate the experience with PBAs and/or TBAs and to determine whether 7αC4 is a good screening biomarker for BAM in clinical practice.

MATERIAL AND METHODS

An ambispective study of patients with chronic diarrhea was conducted. BAM was considered present with 7αC4 > 55 ng/mL (cost $420.00 USD), PBAs ≥ 9.8%, TBAs > 2,337 μmol/48 h, or TBAs > 1,000 μmol/48 h + PBAs > 4% (TBAs + PBAs) ($405.00 USD). However, those tests must be shipped to the US for their analysis (total cost $825.00 USD). Data were compared using the chi-square test and Student's t test, and Spearman's Rho correlations were calculated.

RESULTS

We analyzed 48 patients with 7αC4 (age: 58.4 ± 16.9, women: 54.2%). BAM was confirmed by 7αC4 in 12.5%, by PBAs in 38.9%; by TBAs in 5.5%, and by TBAs + PBAs in 16.7%. We found elevated 7αC4 in patients with high or normal PBA/TBA levels (correlation with TBAs: 0.542, p = 0.020; PBAs: -0.127, p = 0.605; TBAs + PBAs: -0.200, p = 0.426). Lastly, BAM identified by 7αC4 was more frequent in patients with previous cholecystectomy (22.7%) vs. those without (3.8%).

CONCLUSIONS

Our study confirms that 7αC4 correlates well with TBAs and is a good biomarker for BAM screening because it can be elevated, despite normal PBA/TBA levels. Additionally, it represents a 49% cost savings in BAM investigation.

摘要

引言与目的

胆汁酸吸收不良（BAM）是导致30%以腹泻为主的肠易激综合征（IBS - D）或功能性腹泻病例以及63.5%胆囊切除术后腹泻病例的原因。SeHCAT是金标准诊断方法，但在墨西哥无法使用。另外，有人提出将48小时粪便中初级胆汁酸（PBA）和总胆汁酸（TBA）的测定以及7αC4测量作为筛查试验。

目的

我们的目的是评估PBA和/或TBA的应用经验，并确定7αC4在临床实践中是否是BAM的良好筛查生物标志物。

材料与方法

对慢性腹泻患者进行了一项前瞻性研究。当7αC4>55 ng/mL（费用420.00美元）、PBA≥9.8%、TBA>2337 μmol/48小时或TBA>1000 μmol/48小时+PBA>4%（TBA + PBA）（405.00美元）时，认为存在BAM。然而，这些检测必须运往美国进行分析（总费用825.00美元）。使用卡方检验和学生t检验比较数据，并计算Spearman等级相关系数。

结果

我们分析了48例进行7αC4检测的患者（年龄：58.4±16.9，女性：54.2%）。通过7αC4确诊BAM的占12.5%，通过PBA确诊的占38.9%；通过TBA确诊的占5.5%，通过TBA + PBA确诊的占16.7%。我们发现PBA/TBA水平高或正常的患者中7αC4升高（与TBA相关性：0.542，p = 0.020；与PBA相关性：-0.127，p = 0.605；与TBA + PBA相关性：-0.200，p = 0.426）。最后，既往有胆囊切除术的患者中通过7αC4确诊的BAM更常见（22.7%），而无胆囊切除术的患者中为（3.8%）。