血清中胆汁酸（BA）的积累是危重患者的常见现象，并且在急性呼吸窘迫综合征（ARDS）患者中也发现了这种情况，其中肝脏和胆道功能可能会受到潜在疾病过程和后续治疗的影响。措施。我们假设甘氨酸与牛磺酸的结合比（G/T 比）可以预测 ARDS 患者的预后，并且支持我们之前发表的假设，即 BA 谱反映了在遭受痛苦时胆汁酸产生的（不良）适应性反应来自疾病或综合症，例如 ARDS。在 70 名 ARDS 患者中，我们使用 LC-MS/MS 方法测定了蛋白沉淀血清样品中的结合 BA 分数，并计算了 G/T 比，然后与健康对照组进行比较。在 ARDS 患者中，由于牛磺酸结合的 BA 增加，G/T 比值明显低于对照组。G/T 比率在诊断当天最低，并在随后的几天内稳定增加（对照 = 3.80 (2.28–4.44)；第 0 天 = 1.79 (1.31–3.86)；第 3 天 = 2.91 (1.71–5.68)；第 3 天 = 2.91 (1.71–5.68)） 5 = 2.28 (1.25–7.85)，第 0 天和第 3 天之间 ( p = 0.019) 以及第 0 天和第 5 天之间 ( p = 0.031)显着增加 。G/T 比与 SAPS II 评分显着相关第 0 天 ( p = 0.009) 和第 3 天 ( p = 0.036) 以及生存期 ( p = 0.006)。关于生存期，接受者-操作者特征显示曲线下面积为 0.713 (CI 0.578–0.848)， Youden 指数显示 G/T 比截止水平为 2.835（敏感性 78.4%，特异性 63.2%）。我们的研究结果进一步支持我们之前发表的假设，即 BA 谱的改变代表严重疾病状态下的适应性机制。我们目前研究还发现，牛磺酸结合的 BA 增加是通过血清中结合的 BA 的 G/T 比降低来表达的。使用 2.8 的阈值 G/T 比，第 3 天的 G/T 比是均匀的与生存相关（p = 0.006）；这些结果还有待后续研究证实。
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A reduced glycine-to-taurine ratio of conjugated serum bile acids signifies an adaptive mechanism and is an early marker of outcome in acute respiratory distress syndrome
The accumulation of Bile Acids (BA) in serum is a common finding in critically ill patients and has been found in patients with Acute Respiratory Distress Syndrome (ARDS), where liver and biliary function could be essentially affected by the underlying disease process and subsequent therapeutic measures. We hypothesized that the glycine-to-taurine conjugation ratio (G/T-ratio) is predictive of outcome in ARDS patients and would support our previously published hypothesis that the BA profile reflects a (mal-) adaptive response of bile acid production when suffering from a disease or syndrome such as ARDS. In 70 patients with ARDS, we determined conjugated BA fractions from protein precipitated serum samples using a LC–MS/MS method and calculated the G/T-ratios, which were then compared with a healthy control group. In patients with ARDS, the G/T-ratio was markedly lower compared to the control group, due to an increase in taurine-conjugated BA. The G/T ratio was lowest on the day of diagnosis and increased steadily during the following days (control = 3.80 (2.28–4.44); day 0 = 1.79 (1.31–3.86); day 3 = 2.91 (1.71–5.68); day 5 = 2.28 (1.25–7.85), significant increases were found between day 0 and day 3 (p = 0.019) and between day 0 and day 5 (p = 0.031). G/T-ratio was significantly correlated with SAPS II score on day 0 (p = 0.009) and day 3 (p = 0.036) and with survival (p = 0.006). Regarding survival, the receiver-operator characteristic revealed an area-under-the-curve of 0.713 (CI 0.578–0.848), the Youden index revealed a G/T-ratio cut-off level of 2.835 (sensitivity 78.4%, specificity 63.2%). Our findings further support our previously published hypothesis that alterations in BA profiles represent adaptive mechanisms in states of severe disease. Our current study adds the finding of an increase in taurine-conjugated BA expressed by a decrease in the G/T-ratio of conjugated BA in serum. The G/T-ratio on day 3 using a threshold G/T-ratio of 2.8 was even associated with survival (p = 0.006); these results are yet to be confirmed by subsequent studies.
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