A comparison of zinc metabolism, inflammation, and disease severity in critically ill infected and noninfected adults early after intensive care unit admission
A comparison of zinc metabolism, inflammation, and disease severity in critically ill infected and noninfected adults early after intensive care unit admission
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DOI：
10.3945/ajcn.110.008417
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发表时间：
2011-06-01
影响因子：
7.1
通讯作者：
Knoell, Daren L.
中科院分区：
文献类型：
--
作者：
Besecker, Beth Y.;Exline, Matthew C.;Knoell, Daren L.
背景：锌缺乏是免疫功能障碍和感染的原因。先前的人类研究表明，急性期反应的激活会改变锌的代谢。锌代谢的改变是否可以预测危重疾病的严重程度尚不清楚。目的：我们试图确定感染（脓毒症）和非感染受试者之间危重疾病发作时锌代谢是否存在差异。设计：我们在三级甲等医院的成人重症监护病房（MICU）中进行了这项前瞻性研究。受试者在进入重症监护病房后 24 小时内入组。不符合脓毒症标准的受试者被考虑纳入危重病对照（CIC）组。经患者同意后，立即采集血液以测量血浆锌和细胞因子浓度以及外周血单核细胞中锌转运蛋白基因的表达。还记录了 MICU 住院期间的临床数据。 结果：总共对 56 名患者进行了评估（22 名脓毒症患者、22 名 CIC 患者和 12 名健康受试者）。 CIC 患者的血浆锌浓度低于正常水平，脓毒症患者的血浆锌浓度进一步降低（57.2 +/- 18.2 与 45.5 +/- 18.1 mu g/dL 相比）。细胞因子浓度随着血浆锌浓度的降低而增加（P = 0.05）。 SLC39A8基因表达在血浆锌浓度最低和疾病严重程度最高的患者中最高。结论：脓毒症患者锌代谢的改变比非感染危重患者更明显。具体来说，脓毒症与较低的血浆锌浓度和较高的 SLC39A8 mRNA 表达相关，这与疾病严重程度的增加（包括心血管功能障碍）相关。美国临床营养杂志 2011；93：1356-64。
Background: Zinc deficiency is a cause of immune dysfunction and infection. Previous human studies have shown that the activation of the acute phase response alters zinc metabolism. Whether the alteration in zinc metabolism is predictive of disease severity in the setting of critical illness is unclear.Objective: We sought to determine whether differences occur in zinc metabolism at the onset of critical illness between infected (septic) and noninfected subjects.Design: We conducted this prospective study in an adult medical intensive care unit (MICU) at a tertiary care hospital. Subjects were enrolled within 24 h of intensive care unit admission. Subjects who did not meet sepsis criteria were considered for the critically ill control (CIC) arm. After patient consent, blood was immediately collected to measure plasma zinc and cytokine concentrations and zinc transporter gene expression in peripheral blood monocytes. Clinical data during the MICU stay were also recorded.Results: A total of 56 patients were evaluated (22 septic, 22 CIC, and 12 healthy subjects). Plasma zinc concentrations were below normal in CIC patients and further reduced in the septic cohort (57.2 +/- 18.2 compared with 45.5 +/- 18.1 mu g/dL). Cytokine concentrations increased with decreasing plasma zinc concentrations (P = 0.05). SLC39A8 gene expression was highest in patients with the lowest plasma zinc concentrations and the highest severity of illness.Conclusions: The alteration of zinc metabolism was more pronounced in septic patients than in noninfected critically ill patients. Specifically, sepsis was associated with lower plasma zinc concentrations and higher SLC39A8 mRNA expression, which correlated with an increased severity of illness, including cardiovascular dysfunction. Am J Clin Nutr 2011;93:1356-64.