【摘要】 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间有明显差异。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16.23μmol/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。更多还原

【Abstract】 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)and 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 ChildPugh 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.更多还原