Tienboon Prasong
Division of Nutrition, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Asia Pac J Clin Nutr. 2003;12(1):61-5.
Nutritional deficiencies have been variably observed in thalassaemia and the aetiology of many of the immune abnormalities in thalassaemic children are poorly defined. Therefore, we tested the hypothesis that certain immune abnormalities have a nutritional basis. Nutritional status, selective quantitative and functional indices of immunity were studied in twelve children (7 females, 5 males; mean age 28 months, SD 5 and range 19.8-35.5), with thalassaemia major before and after a one month period of intensive nutrition support (the study diet consisted of 'Enfapro' liquid formula (Mead Johnson) with added dextrose and corn oil to achieve a caloric density of 1.1 kcal/cc in addition to vitamins and minerals). Each child was provided approximately 150 kcal/day and 4 g of protein/day. Lymphocyte proliferation to Concanavalin A (Con A) (P = 0.008) and Purified Protein Derivative (PPD) (P = 0.002) was depressed upon entry into the study, however the response to Con A attained normal values by the end of the intervention. Compared to baselines, the proliferative response to Con A (P = 0.005) and Phytohemagglutinin A (PHA) (P = 0.031) both improved after the nutrition support. Although there was no general correlation of zinc status with lymphocyte proliferation, normal baseline zinc status was associated with improvement of proliferation. The %CD4 increased (P = 0.036), primarily because of a decrease in total lymphocytes and to lesser extent a decrease in CD8 lymphocytes. Serum immunoglobulin concentrations were found to be elevated on admission but were not significantly affected by the nutrition intervention. C3 concentrations were uniformly depressed on admission but increased by the end of the study protocol (P = 0.037). C4 and CH50 activity were not significantly influenced by the intervention. In conclusion, children with beta thalassaemia have abnormalities of lymphocyte function as well as key complement components that are responsive to nutrition support. In addition, zinc status appears to have an important role in lymphocyte function in these children.
地中海贫血患者中营养缺乏情况存在差异，且地中海贫血儿童许多免疫异常的病因尚不明确。因此，我们检验了这样一个假设，即某些免疫异常有营养方面的基础。我们对12名重型地中海贫血儿童（7名女性，5名男性；平均年龄28个月，标准差5，范围19.8 - 35.5）在接受为期1个月的强化营养支持前后的营养状况、免疫的选择性定量和功能指标进行了研究（研究饮食由“恩发罗”液体配方奶粉（美赞臣）组成，添加了葡萄糖和玉米油，以达到1.1千卡/立方厘米的热量密度，此外还添加了维生素和矿物质）。每个儿童每天摄入约150千卡热量和4克蛋白质。在进入研究时，对刀豆蛋白A（Con A）（P = 0.008）和纯化蛋白衍生物（PPD）（P = 0.002）的淋巴细胞增殖受到抑制，然而在干预结束时，对Con A的反应达到了正常水平。与基线相比，营养支持后对Con A（P = 0.005）和植物血凝素A（PHA）（P = 0.031）的增殖反应均有所改善。虽然锌状态与淋巴细胞增殖没有普遍相关性，但正常的基线锌状态与增殖改善相关。CD4百分比增加（P = 0.036），主要是因为总淋巴细胞减少，以及在较小程度上CD8淋巴细胞减少。血清免疫球蛋白浓度在入院时升高，但营养干预对其影响不显著。入院时C3浓度均降低，但在研究方案结束时升高（P = 0.037）。C4和CH50活性不受干预的显著影响。总之，β地中海贫血儿童存在淋巴细胞功能异常以及对营养支持有反应的关键补体成分异常。此外，锌状态似乎在这些儿童的淋巴细胞功能中起重要作用。
