嚴重病毒性肝硬化病人血清鋅值與白蛋白的關係

背景與目的：鋅是人體必需的微量礦物質，也是生理代謝的要角，缺乏時會導致許多病症，或加重病況，肝硬化則是其中之一。肝硬化病人也容易因攝取不足與排出增加而發生鋅缺乏，更容易發生肝性腦病變等症狀，補充鋅後可以改善，尤其酒精性肝硬化更明顯。在台灣肝硬化以病毒性居多，血清鋅的變化可能有差異，值得探討。但鋅的檢驗並不普遍，若加入一般常用的生化檢驗中來提醒注意，則能提早發現缺乏鋅的肝硬化病人。本實驗嘗試評估鋅與生化檢驗的關係。材料與方法：收集2002年九月至2004年二月，介於20～80歲，病毒性B型或C型性肝硬化病人。經其同意後，至少在三至六個月病況穩定情況下進行臨床診斷、超音波檢查生化檢驗。一年內有酗酒病史，使用大量利尿劑、肌酐酸值大於2mg/dl、使用類固醇、近日有輸血、感染症狀者排除於外。我們記錄其性別、體重、身高，檢查項目包括血液常規，凝血功能，肝功能等，以及血清鋅值。再統計分析鋅與各檢驗間關係，特別著重鋅和蛋白的線性相關。結果：共31位病人，男女分別為16位與15位，平均年齡59.3±11.7歲。慢性B型C型肝炎各有22位與9位。Child-Pugh A，B，C等級分別是1，24與6位。生化檢驗蛋白質總量7.25±0.83 gm/dl，白蛋白3.24±0.57gm/dl，總膽紅素2.47±2.1 mg/dl，膽固醇150.9±93.1 mg/dl，三酸甘油酯72.2±22.9 mg/dl。血清鋅值為662.4±121.5μg/L，隨著白蛋白下降。血清鋅值與其呈現有意義線性相關，R=0.644，P=0.034，與其他檢驗值皆無相關性。結論：雖然多數台灣病毒性肝硬化病人營養狀態尚可，但血清鋅值仍有低下現象，其血清鋅值與白蛋白值更呈現明顯有線性相關。尤其白蛋白低於3.5 gm/dl時，血清鋅值絕多數會小於700μg/L。適量的補充鋅，可能可改善肝硬化病人如肝性腦病變、肌肉抽筋、味覺遲鈍等症狀。若再加上整體營養與白蛋白的改善，或許更能有效的提高鋅值與其效果。後續研究將再探討營養改善後白蛋白與鋅的變化。

關鍵字

肝硬化；鋅；白蛋白

並列摘要

Zinc is an important trace element and it participates in metabolism and several processes of diseases. Zinc deficiency is common in patients with liver cirrhosis and might cause relative complications. Early zinc supplement may prevent and improve hepatic encephalopathy and other symptoms of cirrhosis. We investigate the correlations between serum biochemistry data and serum zinc level and try to seek a land marker for detecting zinc deficiency in general practice. From Sep 2002 to Jun 2004, we collected serum biochemistry profiles and zinc level in patients with stable advanced viral cirrhosis. Thirty-one patients (16 men and 15 women) at the age of 20 to 80 years old who had Child-Pugh grade B and C cirrhosis were enrolled in this study. The excluded criteria were alcoholic dependant, recent blood transfusion or systemic infections, abnormal renal function, and large amount diuretic or steroid use. Twenty-two patients had chronic hepatitis B and 9 patients had chronic hepatitis C. The mean serum albumin was 3.24±0.57 gm/dl and mean serum zinc was 662.4±121.5 μg/L. The correlations were analyzed by linear regression. Serum zinc level is related to albumin level in these cirrhotic patients (R=0.644, P=0.034). There is no correlation between zinc and total protein, grade of cirrhosis and other biochemistry parameters. We concluded that most of viral cirrhotic patients in Taiwan may not have obvious malnutrition. The serum zinc is usually lower and has significant relation to the serum albumin level. Albumin below the lower normal limit 3.5 gm/dl may be a useful clue to detect zinc deficiency that may be induced hepatic encephalopathy and general malaise. As we known, not only the improvement of albumin level but also the general nutrition support is important for increasing serum zinc that might be of benefit for cirrhotic patients.

並列關鍵字

Liver cirrhosis ； Zinc ； Albumin

國際替代計量

嚴重病毒性肝硬化病人血清鋅值與白蛋白的關係

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