The Use of Prealbumin and C-Reactive Protein for Monitoring Nutrition Support in Adult Patients Receiving Enteral Nutrition in an Urban Medical Center
The Use of Prealbumin and C-Reactive Protein for Monitoring Nutrition Support in Adult Patients Receiving Enteral Nutrition in an Urban Medical Center
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DOI：
10.1177/0148607111413896
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发表时间：
2012-03-01
影响因子：
3.4
通讯作者：
Peterson, Sarah
中科院分区：
文献类型：
--
作者：
Davis, Cassie Jo;Sowa, Diane;Peterson, Sarah
背景：血清白蛋白前（PAB）通常用于评估蛋白质状态，并常用于监测对营养支持的反应。然而，在炎症期间，肝脏以牺牲PAB为代价合成急性期蛋白，如c反应蛋白（CRP）。目的：本回顾性研究的目的是确定在接受肠内营养（n = 154）的住院成人（>= 18岁）中，PAB的变化是否反映了足够营养的输送或炎症状态的变化。方法：比较蛋白质和能量摄入的变化，在基线和每周两次评估PAB。当PAB < 18 mg/dL时评估c反应蛋白，以确定炎症的存在和严重程度。结果：在大多数危重患者的样本中，接受>= 60%卡路里需求（2.74 +/- 9.50 mg/dL）的患者与接受>= 60%卡路里需求（2.48 +/- 9.36 mg/dL; P = 0.86）的患者的PAB变化无显著差异。PAB的变化仅与CRP的变化相关（r = -0.544, P < 0.001）。在一项对62名反复测量PAB和CRP的患者进行的亚组分析中，PAB仅在热量输送的最低2分位数和蛋白质输送的最低1分位数中显著增加。结论：这些结果表明PAB可能不是评估炎症危重患者营养支持是否充足的敏感指标。只有CRP的变化能够显著预测PAB的变化，这表明炎症的改善，而不是营养摄入，是PAB水平增加的原因。（中华儿科杂志。2012;36:197-204）
Background: Serum prealbumin (PAB) is commonly used to assess protein status and is often used to monitor the response to nutrition support. However, during inflammation, the liver synthesizes acute-phase proteins such as C-reactive protein (CRP) at the expense of PAB. Objective: The purpose of this retrospective study was to determine whether changes in PAB reflect the delivery of adequate nutrients or changes in inflammatory status in hospitalized adults (>= 18 years) receiving enteral nutrition (n = 154). Methods: Protein and energy intake were compared to changes in PAB, assessed at baseline and twice weekly. C-reactive protein was assessed when PAB was < 18 mg/dL to determine the presence and severity of inflammation. Results: In a sample of mostly critically ill patients, there was no significant difference in change in PAB for those receiving >= 60% of calorie needs (2.74 +/- 9.50 mg/dL) compared to < 60% of calorie needs (2.48 +/- 9.36 mg/dL; P = .86). Changes in PAB correlated only with changes in CRP (r = -0.544, P < .001). In a subgroup analysis of 62 patients with repeated measures of PAB and CRP, PAB increased significantly only in the bottom 2 tertiles for calorie delivery and the lowest tertile for protein delivery. Conclusions: These results indicate that PAB may not be a sensitive marker for evaluating the adequacy of nutrition support in critically ill patients with inflammation. Only change in CRP was able to significantly predict changes in PAB, suggesting that an improvement in inflammation, rather than nutrient intake, was responsible for the increases in PAB levels. (JPEN J Parenter Enteral Nutr. 2012;36:197-204)