Narkewicz M R, Krebs N, Karrer F, Orban-Eller K, Sokol R J
Department of Pediatrics, The Pediatric Liver Center, University of Colorado School of Medicine and The Children's Hospital, Denver, CO 80218, USA.
Hepatology. 1999 Mar;29(3):830-3. doi: 10.1002/hep.510290322.
Zinc deficiency is a relatively common problem in children with chronic liver disease. We have previously shown inappropriate urinary zinc excretion in children with chronic liver disease and hypozincemia. This study was designed to determine if zinc deficiency and inappropriate urinary zinc losses are corrected in children with liver disease by liver transplantation. Thirty-three patients (age 1-19 years) underwent 35 liver transplants for acute and chronic liver disease. At the time of transplant, 17 patients had low plasma zinc (hypozincemic) (plasma zinc, 45.4 +/- 1.8 microg/dL), whereas 18 had normal plasma zinc (75.7 +/- 3.8). Before transplant, patients with zinc deficiency had higher urinary zinc to creatinine ratio compared with those with normal zinc status (6.6 +/- 1.9 vs. 2.2 +/- 0.6; P =.03) and lower serum albumin concentrations (low: 2.8 +/- 0.1 vs. normal: 3.3 +/- 0.2; P =.02). After transplant, there was a significant reduction in urinary zinc losses in the hypozincemic group followed by normalization of plasma zinc levels by 7 days posttransplant. These data suggest that the abnormal renal zinc homeostasis that is present in approximately 50% of pediatric patients undergoing liver transplant is rapidly improved and biochemical zinc deficiency is reversed after liver transplantation.
锌缺乏在患有慢性肝病的儿童中是一个相对常见的问题。我们之前已经表明，患有慢性肝病和低锌血症的儿童存在尿锌排泄不当的情况。本研究旨在确定肝病患儿通过肝移植是否能纠正锌缺乏和不当的尿锌流失。33例患者（年龄1 - 19岁）因急性和慢性肝病接受了35次肝移植。在移植时，17例患者血浆锌水平较低（低锌血症）（血浆锌，45.4±1.8μg/dL），而18例患者血浆锌水平正常（75.7±3.8）。移植前，锌缺乏患者的尿锌与肌酐比值高于锌状态正常的患者（6.6±1.9对2.2±0.6；P = 0.03），且血清白蛋白浓度较低（低：2.8±0.1对正常：3.3±0.2；P = 0.02）。移植后，低锌血症组的尿锌流失显著减少，移植后7天血浆锌水平恢复正常。这些数据表明，大约50%接受肝移植的儿科患者中存在的异常肾锌稳态在肝移植后迅速改善，生化性锌缺乏得到逆转。
