2005 16 11-17
92
1 2 1 2 1 1 1 2 1 1
1
2
2002 2004
20~80
2 mg/dl
31 16 15
59.3 11.7 B C 22 9 Child-Pugh A,B, C
1, 24 6 7.25 0.83 gm/dl 3.24 0.57 gm/dl
2.47 2.1 mg/dl 150.9 93.1 mg/dl 72.2 22.9 mg/dl
662.4 121.5 g/L R = 0.644
P = 0.034
3.5 gm/dl 700 g/L
( Liver cirrhosis ) ( Zinc )
( Albumin )
1
2
3-4 5
6
7 - 8
9
10
4
11
2 0 0 2
2 0 0 4 B C
20~80 Child-Puph B C
Child-Puph C
B C
Furosemide ( 40 mg ) spironolactone (25 mg )
2 mg/dl
( simple linear regression ) SPSS
3 1
16 15
59.3 11.7 B
22 C 9 61.3 10.1
157.8 11.1
Child-Pugh ( )
B
6 A 2 3
10.94 1.77 gm/dl 4730 2200/mm3
22.4 14.1%
84.3 43.4K 13.8 1.6 INR 1.3 1.4
7.25 0.83 gm/dl 3.24
0.57 gm/dl ( 19 3.5 gm/dl ) 2.47 2.1 mg/dl
150.9 93.1 mg/dl 72.2 22.9
mg/dl ( ) 662.4 121.5 g/L
790 g/L
R = 0.644, B=136.3, Alpha=220.6, CI= 0.95, P = 0.034 ( )
Child-Pugh
( )
13
16 15
22 9 Child-Pugh
1* 24
6
*
Child-Pugh
1 9 6 0
12 1974
300
( alkaline phosphatase ) 2 0 0 0
( transcription factors )
13
14-15 16
15mg
1 2 m g 1 5 -
25mg
( malabsorption syndrome )
17
18
(%) 22.4 14.1 20-40 0.959
(x1000/mm3) 84.3 43.4 140-450 0.179
PT ( ) 13.8 1.6 9-13 0.207
INR 1.35 0.29 < 2 0.219
(gm/dl) 106.8 37.8 70-120 0.055
(gm/dl) 7.25 0.83 6-8 0.457
(gm/dl)* 3.24 0.57 3.5-5.0 0.034
(mg/dl) 2.47 2.1 0.2-1.3 0.627
(mg/dl) 0.84 1.30 < 0.4 0.469
(u/l) 115.7 60.1 35-104 0.866
GOT(u/l) 73.7 34.2 5-35 0.526
GPT(u/l) 48.1 21.0 5-30 0.733
(mg/dl) 150.9 93.1 130-230 0.716
(mg/dl) 72.2 22.9 35-165 0.915
(mg/dl) 0.98 0.25 0.5-1.3 0.184
( g/L) 662.4 121.5
* p < 0.05
19
3.5 gm/dl 7 0 0 g / L 3.5 gm/dl 19
7 0 0 g / L
20
585
21
22
1.
2.
3.5gm/dl 3.
4.
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2.Poo JL, Rosas-Romero R, Rodriguez F, et al. Serum zinc con- centrations in two cohorts of 153 healthy subjects and 100 cir- rhotic patients from Mexico City. Dig Dis 1995; 13: 136-42.
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4.Yoshida Y, Higashi T, Nouso K, et al. Effects of zinc deficien- cy/zinc supplementation on ammonia metabolism in patients with decompensated liver cirrhosis. Acta Med Okayama 2001;
55: 349-55.
5.Bresci G, Parisi G, Banti S. Management of hepatic en- cephalopathy with oral zinc supplementation: a long-term treat- ment. Eur J Med 1993; 2: 414-6.
6.Ozbal E, Helvaci M, Kasirga E, Akdenizoglu F, Kizilgunesler A. Serum zinc as a factor predicting response to interferon- alpha2b therapy in children with chronic hepatitis B. Biol Trace Elem Res 2002; 90: 31-8.
7.Kugelmas M. Preliminary observation: oral zinc sulfate re- placement is effective in treating muscle cramps in cirrhotic patients. J Am Coll Nutr 2000; 19: 13-5.
8.Baskol M, Ozbakir O, Coskun R, Baskol G, Saraymen R, Yucesoy M. The role of serum zinc and other factors on the prevalence of muscle cramps in non-alcoholic cirrhotic patients.
J Clin Gastroenterol 2004; 38: 524-9.
15
holic cirrhosis with diet therapy. Trop Gastroenterol 1995; 16:
119-22.
12.Black RE. Zinc deficiency, infectious disease and mortality in the developing world. J Nutr 2003; 133: 1485S-9S.
13.Coleman JE. Zinc proteins: enzymes, storage proteins, tran- scription factors, and replication proteins. Annu Rev Biochem 1992; 61: 897-946.
14.Beck FW, Prasad AS, Kaplan J, Fitzgerald JT, Brewer GJ.
Changes in cytokine production and T cell subpopulations in ex- perimentally induced zinc-deficient humans. Am J Physiol 1997; 272: E1002-7.
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17
Correlation Between Serum Zinc and
Albumin Level in Severe Viral Cirrhosis Patients
Tsang-En Wang1, 2, Ming-Jen Chen1, 2, Shou-Chuan Shih1, 2, Chia-Yung Lieu1, Cheng-Hsin Chu1, 2, Horng-Yuan Wang1, and Wen-Hsinug Chang1
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 supple- ment may prevent and improve hepatic encephalopathy and other symptoms of cirrhosis. We investigate the cor- relations 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 crite- ria 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 g/L. The correla- tions 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 bio- chemistry parameters. We concluded that most of viral cirrhotic patients in Taiwan may not have obvious mal- nutrition. 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 en- cephalopathy and general malaise. As we known, not only the improvement of albumin level but also the gene- ral nutrition support is important for increasing serum zinc that might be of benefit for cirrhotic patients. ( J Intern Med Taiwan 2005; 16: 11-17 )
1
Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
2
