Reid Marvin, Badaloo Asha, Forrester Terrence, Morlese John F, Heird William C, Jahoor Farook
US Department of Agriculture, Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030-2600, USA.
Am J Clin Nutr. 2002 Dec;76(6):1409-15. doi: 10.1093/ajcn/76.6.1409.
Immune structure and function are more compromised in edematous protein-energy malnutrition (PEM) than in nonedematous PEM. Whether the positive acute-phase protein (APP) response to infection is affected remains unknown.
We assessed whether children with edematous PEM can mount a general APP response and compared the kinetic mechanisms of the response in children with edematous PEM with those in children with nonedematous PEM.
Plasma C-reactive protein, alpha(1)-acid glycoprotein, alpha(1)-antitrypsin, haptoglobin, and fibrinogen concentrations and the fractional and absolute synthesis rates of alpha(1)-antitrypsin, haptoglobin, and fibrinogen were measured in 14 children with edematous PEM, aged 11.4 +/- 2 mo, and 9 children with nonedematous PEM, aged 10.1 +/- 1.4 mo, at 3 times: approximately 2 d after hospital admission (period 1), when they were malnourished and infected; approximately 8 d after admission (period 2), when they were malnourished but free of infection; and approximately 54 d after admission (period 3), when they had recovered.
Children with edematous and nonedematous PEM had higher plasma concentrations of 4 of 5 APPs in period 1 than in period 3. The magnitude of the difference in concentration and in the rate of synthesis of the individual APPs was less in the children with edematous PEM than in those with nonedematous PEM. The kinetic data show that the characteristics of the APP response were different in the 2 groups.
These results suggest that severely malnourished children can mount only a partial APP response to the stress of infection and that the magnitude of this response is less in those with edema.
与非水肿型蛋白质 - 能量营养不良（PEM）相比，水肿型PEM患者的免疫结构和功能受损更严重。感染时急性期反应蛋白（APP）的阳性反应是否受到影响尚不清楚。
我们评估了水肿型PEM患儿是否能产生全身性APP反应，并比较了水肿型PEM患儿与非水肿型PEM患儿该反应的动力学机制。
对14名年龄为11.4±2个月的水肿型PEM患儿和9名年龄为10.1±1.4个月的非水肿型PEM患儿，在3个时间点测量血浆C反应蛋白、α1 - 酸性糖蛋白、α1 - 抗胰蛋白酶、触珠蛋白和纤维蛋白原浓度，以及α1 - 抗胰蛋白酶、触珠蛋白和纤维蛋白原的分数合成率和绝对合成率：入院后约2天（第1期），此时他们营养不良且感染；入院后约8天（第2期），此时他们营养不良但未感染；入院后约54天（第3期），此时他们已康复。
在第1期，水肿型和非水肿型PEM患儿血浆中5种APP中的4种浓度高于第3期。水肿型PEM患儿个体APP浓度和合成率的差异幅度小于非水肿型PEM患儿。动力学数据表明，两组APP反应的特征不同。
这些结果表明，严重营养不良的儿童对感染应激只能产生部分APP反应，且水肿患儿的这种反应幅度较小。
