血清Cu Zn浓度及其比值在肝硬化患者中的诊断效率

Diagnostic Efficiency of Serum Copper,Zinc Concentrations and Copper-to-zinc Ratios in Patients with Liver Cirrhosis

目的：探讨血清Cu、Zn浓度及其Cu／Zn比值肝硬化患者中的诊断价值。方法：测定了67例肝硬化患者和32例健康对照血清Cu、Zn浓度及其Cu／Zn比值，并对肝硬化患者进行了Child-Pugh分级统计处理。用ROC曲线分析评价了Cu、Zn元素及其Cu／Zn比值对肝硬化的诊断性能。结果：肝硬化患者血清Cu（t=5．656。P=0．000）和Cu／Zn比值（t=10．741，P=0．000）均明显高于健康受试者，而血清Zn则明显低于健康受试者（t=19．931，P=0．000）。经Child-Pugh分级后，血清Cu、Zn浓度及其Cu／Zn比值在各亚组间没有统计学差异。血清Cu、Zn浓度及其Cu／Zn比值肝硬化患者有无脑病并发让有明显差异。ROC曲线分析显示，难以找到一个合适的判断线，以使血清Cu对诊断肝硬化有较好的灵敏度和特异性。血清Zn的诊断效率较血清Cu好，若以16．23”mol／L为判断线，其Se=100．0％，Sp=85．1％。相比之下Cu／Zn比值有最佳诊断效率，当判断线为0．89时，其Se=98．5％，Sp=100．0％。AUC（95％可信限）指示ROC曲线的总的诊断效率：Cu是0．789（0．677～0．901）、AUC是0．952（0．916～0，989）、AUC是0．999（0．995～1．002）。结论：血清Cu、Zn浓度及其Cu／Zn比值可能是肝硬化的辅助诊断指标，但真正有诊断价值的指标是Cu／Zn比值。

Objective： To investigate the diagnostic value of serum copper, zinc concentrations and copper- to- zinc ratios in patients with liver cirrhosis. Methods： The levels of serum copper, zinc concentrations and copper- to- zinc ratios in 67 patients with liver cirrhosis （patients divided group by Child - Pugh scores） and 32 healthy controls were measured. Diagnostic Efficiency of serum copper, zinc concentrations and copper- to- zinc ratios were evaluated by Receiver Operating Characteristics （ROC） curve, Results： Serum copper concentrations（ t = 5.656, P = 0. 000 ） a nd copper - to - zinc ratios （ t = 10. 741, P = 0. 000） were found to be significantly higher, and serum zinc concentration was found to be significantly lower（ t = 19. 931, P = 0. 000） in the liver cirrhosis patients than those of controls, As liver cirrhosis patients were divided into 3 groups by Child- Pugh criteria, serum copper, zinc concentrations and copper- to- zinc ratios were no significantly different among each subgroup. Serum copper, zinc concentrations and copper- to- zinc ratios were significantly different between patients with hepatic encephalopathy and cirrhotic patients without encephalopathy. ROC curve revealed that it is difficult to find a cut - off value for Cu with good sensitivity and specificity to diagnose liver cirrhosis. Diagnostic efficiency of serum zinc is bitter than that of serum copper, The sensitivity and specificity serum Zn （at cut- off value 16.23 μmol/L） to diagnose liver cirrhosis were 100.0 % and 85.1% respectively, Diagnostic efficiency of copper - to - zinc ratio was the best in three parameters. When cut - off value was 0.89, its sensitivity and specificity to diagnose liver cirrhosis were 98.5 % and 100.0 % respectively. The total diagnostic efficiency indicated by the area under the ROC curve （AUC） （95 % confidence interval, CI） for Cu was 0,789 （0.677- 0,901）, for Zn was 0.952（0.916-0,989）, and for was Cu/Zn 0.999（0.995-1.002）, respectively. Conclusions：Serum copper, zinc concentrations and copper- to- zinc ratios may be auxiliary makers to diagnose liver cirrhosis. However, copper- to- zinc ratio is only a useful marker for estimating liver cirrhosis.