Copper, selenium, zinc, and thiamine balances during continuous venovenous hemodiafiltration in critically ill patients
Copper, selenium, zinc, and thiamine balances during continuous venovenous hemodiafiltration in critically ill patients
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重症患者持续静脉血液透析过程中的铜、硒、锌和硫胺素平衡
DOI：
10.1093/ajcn/80.2.410
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发表时间：
2004-08-01
影响因子：
7.1
通讯作者：
Chioléro, RL
中科院分区：
文献类型：
--
作者：
Berger, MM;Shenkin, A;Chioléro, RL
背景资料：急性肾功能衰竭是危重患者的严重并发症，经常需要肾脏替代治疗，这会改变微量元素和维生素代谢。目的：目的是研究重症监护患者连续肾脏替代治疗（CRRT）期间的微量元素平衡。设计：在一项前瞻性随机交叉试验中，急性肾功能衰竭患者在连续2个24小时内接受了使用碳酸氢钠（Bic）或乳酸钠（Lac）作为缓冲剂的CRRT。铜，硒，锌，硫胺素测定与高灵敏度的分析方法在血浆中，置换液，和流出物在8小时内。平衡计算为液体管理和流出物损失之间的差异，并与推荐的摄入量（RI）从肠外nutrition.Results：19届会议进行了比较，在11例年龄为65 - 10岁。铜的基线血浆浓度是正常的，而硒和锌低于参考范围;谷胱甘肽过氧化物酶在正常范围的下限。置换液中未检出铜，Se为0.01 μ mol/L（Bic和Lac），Zn为1.42 μ mol/L（Bic）和0.85 μ mol/L（Lac）。在所有流出物中均可检测到微量营养素，并且每个患者的损失都是稳定的; Bic和Lac组之间没有发现显著差异。硒的24小时平衡为阴性（-0.97 mumol，或每日RI的2倍），铜（-6.54 mumol，或每日RI的0.3倍）和硫胺素（-4.12 mg，或RI的1.5倍）和锌中度y阳性（20.7 mumol，或RI的0.2倍）。结论：CRRT导致硒、铜和硫胺素的显著损失和负平衡，导致血浆浓度低。尽管按推荐量补充，但延长CRRT可能导致硒和硫胺素耗竭。
Background: Acute renal failure is a serious complication in critically ill patients and frequently requires renal replacement therapy, which alters trace element and vitamin metabolism.Objective: The objective was to study trace element balances during continuous renal replacement therapy (CRRT) in intensive care patients.Design: In a prospective randomized crossover trial, patients with acute renal failure received CRRT with either sodium bicarbonate (Bic) or sodium lactate (Lac) as a buffering agent over 2 consecutive 24-h periods. Copper, selenium, zinc, and thiamine were measured with highly sensitive analytic methods in plasma, replacement solutions, and effluent during 8-h periods. Balances were calculated as the difference between fluids administered and effluent losses and were compared with the recommended intakes (RI) from parenteral nutrition.Results: Nineteen sessions were conducted in 11 patients aged 65 10 y. Baseline plasma concentrations of copper were normal, whereas those of selenium and zinc were below reference ranges; glutathione peroxidase was in the lower range of normal. The replacement solutions contained no detectable copper, 0.01 mumol Se/L (Bic and Lac), and 1.42 (Bic) and 0.85 (Lac) mumol Zn/L. Micronutrients were detectable in all effluents, and losses were stable in each patient; no significant differences were found between the Bic and Lac groups. The 24-h balances were negative for selenium (-0.97 mumol, or 2 times the daily RI), copper (-6.54 mumol, or 0.3 times the daily RI), and thiamine (-4.12 mg, or 1.5 times the RI) and modest y positive for zinc (20.7 mumol, or 0.2 times the RI).Conclusions: CRRT results in significant losses and negative balances of selenium, copper, and thiamine, which contribute to low plasma concentrations. Prolonged CRRT is likely to result in selenium and thiamine depletion despite supplementation at recommended amounts.