Greuter Thomas, Franc Yannick, Kaelin Matthias, Schoepfer Alain M, Schreiner Philipp, Zeitz Jonas, Scharl Michael, Misselwitz Benjamin, Straumann Alex, Vavricka Stephan R, Rogler Gerhard, von Känel Roland, Biedermann Luc
Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland.
Institute of Social and Preventive Medicine, University of Lausanne, Switzerland.
Therap Adv Gastroenterol. 2018 Feb 19;11:1756283X18757715. doi: 10.1177/1756283X18757715. eCollection 2018.
Zinc deficiency (ZD) in Crohn's disease (CD) is considered a frequent finding and may exacerbate CD activity. ZD is associated with depression in non-CD patients. We aimed to assess the prevalence of ZD in CD patients in clinical remission, its association with mood disturbances and to analyze a potential impact on future disease course.
Zinc levels from CD patients in clinical remission at baseline and an uncomplicated disease course within the next 3 years ( = 47) were compared with those from patients developing complications ( = 50). Baseline symptoms of depression and anxiety were measured with the Hospital Anxiety and Depression scale.
Mean zinc level in the 97 patients (40.4 ± 15.7 years, 44.3% males) was 18.0 ± 4.7 μmol/l. While no ZD (<11 μmol/l) was observed, we found low zinc levels (<15.1 μmol/l) in 28 patients (28.9%). Males had higher zinc levels compared with females (19.4 ± 5.7 16.8 ± 3.3, = 0.006). Patients with low zinc levels more often reported depression symptoms compared with patients with higher levels (27.3 9.4%, = 0.047). In a multivariate analysis, zinc levels were an independent negative predictor for depression symptoms [odds ratio (OR) 0.727, 95% confidence interval (CI) 0.532-0.993, = 0.045]. Zinc levels of patients with a complicated disease course were not different from those of patients without (17.7 ± 4.3 18.3 ± 5.1, n.s.). Baseline zinc levels did not predict disease outcome regardless of ATG16L1 genotype.
Low-normal zinc levels were an independent predictor for the presence of depression symptoms in CD patients. Zinc levels at baseline did not predict a complicated disease course, neither in CD patients overall, nor ATG16L1 carriers.
克罗恩病（CD）患者的锌缺乏（ZD）被认为是常见现象，可能会加重CD的活动。ZD与非CD患者的抑郁有关。我们旨在评估临床缓解期CD患者中ZD的患病率、其与情绪障碍的关联，并分析其对未来疾病进程的潜在影响。
将基线时处于临床缓解期且在接下来3年内疾病进程未出现并发症的CD患者（n = 47）的锌水平与出现并发症的患者（n = 50）的锌水平进行比较。使用医院焦虑抑郁量表测量基线时的抑郁和焦虑症状。
97例患者（年龄40.4±15.7岁，男性占44.3%）的平均锌水平为18.0±4.7μmol/L。虽然未观察到ZD（<11μmol/L），但我们发现28例患者（28.9%）的锌水平较低（<15.1μmol/L）。男性的锌水平高于女性（19.4±5.7对16.8±3.3，P = 0.006）。与锌水平较高的患者相比，锌水平较低的患者更常报告抑郁症状（27.3%对9.4%，P = 0.047）。在多变量分析中，锌水平是抑郁症状的独立负向预测因子[比值比（OR）0.727，95%置信区间（CI）0.532 - 0.993，P = 0.045]。疾病进程出现并发症的患者的锌水平与未出现并发症的患者无差异（17.7±4.3对18.3±5.1，无统计学意义）。无论ATG16L1基因型如何，基线锌水平均不能预测疾病结局。
锌水平略低是CD患者存在抑郁症状的独立预测因子。基线锌水平不能预测疾病的复杂进程，无论是总体CD患者还是ATG16L1携带者。
