Evaluation of the Diagnostic Value of Serum Bile Acid in the Detection and Functional Assessment of Liver Diseases

Abstract

The diagnostic usefulness of fasting total serum bile acids (SBA/F) in the detection of liver diseases and assessment of different aspects of hepatic function alteration was evaluated in 61 healthy subjects and 186 patients with liver disease. The value of SBA/F was compared with other routine tests. In 49 healthy subjects and 92 patients, serum bile acids were also measured after the im administration of Ceruletide as a cholecystokinetic agent (SBA/C). The diagnostic efficacy for the detection of disease states was better with aspartate-aminotransferase (EC 2.6.1.1) and alanine-aminotransferase (EC 2.6.1.2) than with SBA/F. When SBA/C was also determined the diagnostic efficacy was not substantially better than the SBA/F test. In the assessment of hepatocellular necrosis SBA/F showed a higher rate of misclassification errors compared to alanine-aminotransferase (mean error 45% vs 17%), whereas SBA/F gave similar results with direct bilirubin and pseudocholinesterase (EC 3.1.1.8) in the evaluation of cholestasis (mean error 40% vs 41%) and impaired biosynthesis (mean error 39% vs 40%), respectively. Serum bile acid determination did not show any significant diagnostic advantage with respect to the other routine liver tests.

Key discoveries in bile acid chemistry and biology and their clinical applications: history of the last eight decades

“…The major reason is that bile acid levels are probably inferior in sensitivity and specifi city in detecting liver injury when compared with the standard liver panel. This conclusion is based on clinical studies ( 218,219 ). In addition, a recent animal study ( 220 ) in which liver injury was experimentally induced in rats by feeding a variety of toxic molecules found that serum bile acid levels were not more sensitive than aminotransferase levels.…”

Drugs and the liver part 1: Testing liver function

“…When the question of presence or absence of liver disease is considered, the standard liver function tests (serum transaminases, bilirubin, and proteins) will correctly allocate a patient to disease or non-disease in approximately 75 per cent of cases.I8 Overall, the sensitivity, specificity, and predictive accuracy of serum bile acids in the diagnosis of liver disease is similar to that of aspartate aminotransferase,l* as cirrhosis is occasionally 'silent' with normal SLFTs, serum bile acids maybe more sensitive than SLFTs in severe liver disease,I9 although this has been disputed by other authors. 20 The prognostic accuracy of liver function tests in diagnosing diseasehondisease may be enhanced by a combination of both bile acids and SLFTs and a multivariate statistical analysis,I8 but this is too cumbersome to be of practical clinical use. Similarly, using logistic discriminant analysis after measurement of SLFTs, extra-hepatic biliary obstruction n a v be differentiated from metastatic liver disease or hepatocellular necrosis with reasonable confidence.…”

Übersichten

“…Bei der in unkonzentrierter BALF gemessenen Elastase-Aktivität handelt es sich wahrscheinlich um Fehlbestimmungen. Dies ist möglicherweise eine Erklärung für sich widersprechende Ergebnisse in der Literatur (12,16). Die Impräzision von Tag zu Tag war 5,24%, die Impräzision in der Serie 5,45%.…”

“…Seit den 70er Jahren gibt es kontroverse Mitteilungen über den Zusammenhang der Schilddrüsenfunktion mit den hormonellen Veränderungen während des Menstruationszyklus (2,3,15,19), am deutlichsten wurden Schwankungen des Schilddrüsenvolumens nachgewiesen (14). In der vorliegenden Untersuchung lagen die basalen TSH-Konzentrationen in beiden Zyklusphasen innerhalb des von uns ermittelten Referenzbereiches für Frauen ohne Kontrazeptiva (16). Auch zwischen Follikel-und Lutealphase konnte kein signifikanter Unterschied (ß <0,05 bei einem relvanten von 0,5) festgestellt werden (Tab.…”

“…Die Messungen sind sehr sensitiv, richtig und präzise, aber wegen ihres hohen Aufwands für den Routineeinsatz ungeeignet. Die Indikationen zur Untersuchung der Gallensäuren in Serum und Stuhl sind bisher nicht ausreichend definiert, die Spanne reicht von Ablehnung (14,15,16,17,18) der SerumgaUens uren war Rinderserum mit 5, 25 und 100 /Ltmol/l Chenodesoxychols ure (Serum-Gallens uren-Kalibrator; Merck, Darmstadt). Kalibrator f r die Bestimmung der GaHens uren im Stuhl war eine selbst hergestellte L sung von 100 ìôçïÉ/É Chols ure (Sigma, Deisenhofen) in 0,9% NaCL, die portioniert bei -20°C gelagert wurde.…”