Serum copper, ceruloplasmin and 24-h urine copper evaluations in celiac patients.
Dig Dis Sci. 2008 Jun ;53(6):1564-72. PMID: 17934856
Gastroenterohepatology Clinic, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. firstname.lastname@example.org
The aim of the study is to evaluate the serum copper, ceruloplasmin and 24-h urine copper levels in celiac patients. Serum copper, ceruloplasmin and 24-h urine measurements were evaluated in patients with celiac (n = 32), Crohn's (n = 25), Wilson's (n = 11) and in a healthy group (n = 35). Serum and 24-h urine zinc levels, AST, ALT, BUN, creatinine, iron, hemoglobin, hematocrit, lymphocyte, sedimentation and CRP levels were also measured. Results were evaluated statistically and significance was accepted as meaningful if P<0.05. In celiacs, levels of urine copper were high (52 +/- 29 microg/day, P<0.000) but serum copper was the same as in controls (105 +/- 16 microg/dl, P<0.158). High urinary copper of celiacs were coming out in women (56 +/- 30 microg/day) and in man (33 +/- 17 microg/day, P<0.115). Most celiacs were female (P<0.001). Serum copper and ceruloplasmin levels in all groups were higher in women than in men and this was meaningful for serum copper in the control group (P<0.045) and for ceruloplasmin in Crohn's (P<0.055) and control groups (P<0.031). Serum (70 +/- 14 microg/dl, P<0.000) and urine zinc levels (25 +/- 15 microg/dl, P<0.039) of celiacs were low. Ceruloplasmin levels were higher in celiacs (337 +/- 64 U/1) and Crohn's patients (366 +/- 47 U/l, P<0.000). Correlations observed in the groups of celiac (P<0.029) and Crohn's (P<0.024), celiac and Wilson's (P<0.001) and Crohn's and Wilson's (P<0.001) between the ceruloplasmin and 24-h urine copper parameters. AST and ALT levels were higher in celiac and Wilson's patients than in Crohn's patients and controls. Mean CRP levels were significantly higher in Crohn's than others. Lymphocyte counts were meaningfully higher in celiacs. Statistically, while mean iron, hemoglobulin and hematocrit levels of celiac and Crohn groups were meaningfully lower than the normal and Wilson's group, it was similar in Wilson's and the control group. Serum copper (85 +/- 26 microg/dl, P<0.158) and ceruloplasmin (219 +/- 83 U/l, P<0.001) levels were low and 24-h urine copper levels were high (415 +/- 346 microg/day) in Wilson's group. Increased urinary loss may be another cause of copper deficiency in female celiacs besides malabsorption and this topic needs more investigation. Increased urinary copper levels in celiac women should not always be regarded as a diagnosis of Wilson's disease.