Estimation of the effect of the acute phase response on indicators of micronutrient status in Indonesian infants
Estimation of the effect of the acute phase response on indicators of micronutrient status in Indonesian infants
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DOI：
10.1093/jn/131.10.3061
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发表时间：
2002-10-01
影响因子：
4.2
通讯作者：
Muhilal
中科院分区：
文献类型：
--
作者：
Wieringa, FT;Dijkhuizen, MA;Muhilal
由于急性期反应，许多微量营养素状态指标在感染期间发生变化。在这项研究中，通过测量c反应蛋白（CRP）、α(1)-抗凝乳胰蛋白酶（ACT）和α(1)-酸性糖蛋白（AGP）的浓度来评估急性期反应与微量营养素状态指标之间的关系，分析了418名完成6个月随机、双盲、安慰剂对照、补充铁、锌和/或β -胡萝卜素试验的婴儿。急性期反应，定义为CRP升高（血浆浓度>0 mg/L）， AGP升高（>1.2 g/L），或CRP和AGP均升高，显著影响铁、维生素A和锌状态指标，独立于补充的效果。与没有急性期反应的婴儿相比，急性期蛋白升高的婴儿血浆铁蛋白浓度升高15.7 （AGP升高）至21.2 （CRP和AGP升高）马克/升（P < 0.001）。相比之下，视黄醇血浆浓度降低0.07 （P < 0.05，使AGP升高）~ 0.12 （P < 0.01，使CRP升高）μmol/L，锌血浆浓度降低1.49 （P < 0.01，使AGP升高）~ 1.89 （P < 0.05，使CRP和AGP升高）μmol/L。血红蛋白浓度和修饰后的相对剂量反应不受影响。因此，与没有急性期反应的婴儿相比，急性期蛋白升高的婴儿缺铁性贫血的患病率被低估了15%，而维生素A缺乏症的患病率被高估了16%。因此，使用微量营养素状态指标而不考虑急性期反应的影响会导致对微量营养素缺乏的扭曲估计，其程度取决于人群中感染的流行程度。
Many indicators of micronutrient status change during infection because of the acute phase response. In this study, relationships between the acute phase response, assessed by measuring concentrations of C-reactive protein (CRP), alpha(1)-antichymotrypsin (ACT) and alpha(1)-acid glycoprotein (AGP), and indicators of micronutrient status were analyzed in 418 infants who completed a 6-mo randomized, double-blind, placebo-controlled, supplementation trial with iron, zinc and/or beta-carotene. The acute phase response, defined by raised CRP (plasma concentration >10 mg/L), raised AGP (>1.2 g/L), or both raised CRP and AGP, significantly affected indicators of iron, vitamin A and zinc status, independently of the effects of supplementation. Plasma ferritin concentrations were higher by 15.7 (raised AGP) to 21.2 (raised CRP and AGP) mug/L in infants with elevated acute phase proteins compared with infants without acute phase response (P < 0.001). In contrast, plasma concentrations of retinol were lower by 0.07 (P < 0.05, raised AGP) to 0.12 (P < 0.01, raised CRP) μmol/L, and of zinc lower by 1.49 (P < 0.01, raised AGP) to 1.89 (P < 0.05, raised CRP and AGP) μmol/L. Hemoglobin concentrations and the modified relative dose response were not affected. Consequently, the prevalence of iron deficiency anemia was underestimated in infants with raised acute phase proteins by >15%, whereas the prevalence of vitamin A deficiency was overestimated by >16% compared with infants without acute phase response. Hence, using indicators of micronutrient status without considering the effects of the acute phase response results in a distorted estimate of micronutrient deficiencies, whose extent depends on the prevalence of infection in the population.