目的 探析肝硬化患者肝肾阴虚证与湿热蕴结证“病证相关”的血清胆汁酸代谢变化的特征，为中医药治疗肝硬化改善胆汁淤积、胆汁酸代谢障碍方面提供参考依据。方法 临床招募315例肝硬化患者，包括肝肾阴虚证组195例和湿热蕴结证组120例，以150例健康人作为对照组，采用超高效液相色谱联用串联质谱技术(UPLC-MS/MS)对所有血清样本进行血清胆汁酸代谢谱的检测，比较3种病因肝硬化肝肾阴虚证与湿热蕴结证之间“病证相关”的血清胆汁酸代谢谱的差异。结果 肝硬化肝肾阴虚证组（195例）的初级胆汁酸β-MCA显著高于湿热蕴结证(120例) (P < 0.05)，以PBC肝肾阴虚证（55例）尤为显著，其初级胆汁酸GCA、β-MCA以及次级胆汁酸GUDCA、TUDCA、6-ketoLCA、β-UDCA、UDCA水平均显著高于HBC肝肾阴虚证组（134例）(P < 0.05)，CTP-C级时肝硬化肝肾阴虚证组（44例）初级胆汁酸CDCA、GCA、CA水平显著高于湿热蕴结证组（35例）(P < 0.05)；肝硬化湿热蕴结证组的次级胆汁酸NorDCA水平显著高于肝肾阴虚证组(P < 0.05)，ALC湿热蕴结证组（31例）的次级胆汁酸NorCA、LCA显著高于HBC湿热蕴结证组（86例）(P < 0.05)，而HBC湿热蕴结证组（86例）的次级胆汁酸NorDCA显著高于肝肾阴虚证组（134例）（P < 0.05）。结论 肝硬化肝肾阴虚证患者的胆汁淤积及肝细胞胆汁酸代谢障碍为重，PBC患者尤为显著；而肠道菌群紊乱所致次级胆汁酸水平升高可能是肝硬化湿热蕴结证的重要病理基础。
Objective To explore the characteristics of serum bile acid metabolism changes in patients with Gan Shen Yin Xu syndrome and Shi Re Yun Jie syndrome in liver cirrhosis, and to provide reference for treatment of liver cirrhosis by Traditional Chinese Medicine to improve cholestasis and bile acid metabolism.Methods A total of 315 patients with cirrhosis were enrolled in the clinic. Including 195 cases of Gan Shen Yin Xu syndrome group and 120 cases of Shi Re Yun Jie syndrome group, 150 healthy people were used as control group, and used the Ultra-high performance liquid and Chromatography-tandem mass spectrometry (UPLC-MS/MS) to detect the serum bile acid metabolism spectrum of all serum samples, and comparative analysis of serum bile acid metabolism spectrum with “disease-related” in three types of liver cirrhosis was performed between Gan Shen Yin Xu syndrome and Shi Re Yun Jie syndrome.Results The levels of the primary bile acid β-MCA in the Gan Shen Yin Xu syndrome group (195 cases) was significantly higher than the Shi Re Yun Jie syndrome group (120 cases) (P < 0.05). Especially in the Gan Shen Yin Xu syndrome with PBC (55 cases), that its GCA, β-MCA level of the primary bile acid and GUDCA, TUDCA, 6-ketoLCA, β-UDCA, UDCA level of the secondary bile acid were significantly higher than in Gan Shen Yin Xu syndrome group with HBC (134 cases) (P < 0.05), At CTP-C grade ,the levels of primary bile acid CDCA, GCA and CA were significantly higher in Gan Shen Yin Xu syndrome group (44 cases) than the Shi Re Yun Jie syndrome (35 cases) (P < 0.05). The level of secondary bile acid NorDCA in the Shi Re Yun Jie syndrome group was significantly higher than in the Gan Shen Yin Xu syndrome group with liver cirrhosis (P < 0.05), The secondary bile acids NorCA and LCA in the damp-heat syndrome group (31 cases) with ALC were significantly higher than those in the Shi Re Yun Jie group with HBC (86 cases) (P < 0.05).The level of NorDCA in the Shi Re Yun Jie syndrome group(86 cases) of HBC was significantly higher than in the Gan Shen Yin Xu syndrome group (134 cases) (P < 0.05).Conclusion The cholestasis and hepatocyte bile acid metabolism disorders are more severe in patients with Liver cirrhosis of Gan Shen Yin Xu syndrome,especially in patients with PBC, and the high levels of secondary bile acids caused by disturbance of intestinal flora may be an important pathological basis in Shi Re Yun Jie syndrome of Liver cirrohosis.