血清Zn浓度对肝硬化失代偿期患者短期预后的预测价值

The prognostic utility of serum zinc level for predicting 180-day mortality in hospitalized cirrhotics with decompensation

目的探讨血清微量元素Zn浓度对失代偿期肝硬化患者短期预后的预测价值。方法收集天津医科大学总医院消化内科收治住院的失代偿期肝硬化患者100例,原子吸收法检测血清Zn浓度,同时收集患者外周血如血小板、胆红素、肌酐、白蛋白、转氨酶等生化指标和一般资料,电话随访患者出院后180 d生存情况。采用X-tile软件计算评估短期预后的血清Zn浓度最适合阈值,在此基础上,绘制Kaplan-Meier生存曲线,Log-rank检验比较高Zn浓度和低Zn浓度组之间的生存率差异。多因素Cox回归分析确定180 d死亡的独立危险因素。结果X-tile软件计算得到区分失代偿期肝硬化患者180 d生存情况的最佳诊断阈值为0.5 mg/L,根据这一阈值,将患者划分为低Zn浓度组(Zn<0.5 mg/L)和高Zn浓度组(Zn≥0.5 mg/L),高Zn浓度组共77例患者,低Zn浓度组共23例患者,与高Zn浓度组相比其女性患者所占比例更高(78%vs.42%),Child评分C级患者所占比例更高(44%vs.5%),表现为更高的MELD评分(12 vs.10),更高的衰弱指数(0.22 vs.0.09)和更高的碱性磷酸酶(119 U/L vs.91.50 U/L),差异具有统计学意义(P<0.05)。Kaplan-Meier生存分析提示低Zn浓度组肝硬化患者的平均生存率低于高Zn浓度组(Log-rank检验,P<0.001)。多因素Cox比例风险回归分析提示MELD评分(HR=1.152,95%CI:1.070~1.240,P<0.001)和Zn<0.5 mg/L(HR=3.393,95%CI 1.070~10.756,P=0.038)是180 d死亡的独立危险因素。结论血清Zn浓度(<0.5 mg/L)能够作为预测失代偿期肝硬化患者短期预后的独立危险因素。

Objective We intended to investigate the prognostic utility of serum zinc(Zn)level for predicting 180-day mortality in hospitalized decompensated patients with cirrhosis.Methods A total of one hundred patients with cirrhosis was prospectively collected for serum Zn levels,demographic characteristics,biochemical parameters such as platelet,bilirubin,creatinine,albumin and transaminases.The survival status were recorded via telephone contact after discharge from hospital.The optimal cut-off threshold for identifying individuals with high risk of death within 180 days was determined by X-tile software and used in a subsequent Kaplan-Meier survival analysis.Multivariate Cox regression analysis was performed to identify independent risk factor of mortality.Results We determined the most optimized cut off regarding serum Zn level was 0.5 mg/L.Patients with Zn<0.5 mg/L exhibited higher proportion of female(78%vs.42%,P=0.004),higher proportion of CTP-C classification(44%vs.5%,P<0.001),higher MELD score(12 vs.8,P<0.001),higher Frailty Index(0.22 vs.0.09)and higher ALP levels.Moreover,patients with Zn<0.5 mg/L exhibited lower survival rate within 180-day follow-up duration(Log-rank test,P<0.001).Multivariate Cox analysis indicated that higher MELD(HR=1.152,95%CI:1.070~1.240,P<0.001)and Zn<0.5 mg/L(HR=3.393,95%CI 1.070~10.756,P=0.038)were independent risk factors for predicting 180-day mortality in cirrhosis.Conclusion Serum Zn level(<0.5 mg/L)is closely related to short-term in decompensated patients with cirrhosis.