Berger Mette M, Binnert Christophe, Chiolero René L, Taylor William, Raffoul Wassim, Cayeux Marie-Christine, Benathan Messod, Shenkin Alan, Tappy Luc
Department of Adult Intensive Care Medicine & Burns Centre, Lausanne, Switzerland.
Am J Clin Nutr. 2007 May;85(5):1301-6. doi: 10.1093/ajcn/85.5.1301.
After major burns, patients exhibit an intense catabolism, and the wounds require surgery and grafting for closure. Complications, such as weight loss and delayed wound healing, are worsened by trace element (TE) deficiencies.
We aimed to assess the effects of TE supplements on systemic substrate turnover and local protein metabolism during wound healing after major burns.
This was a prospective, randomized, placebo-controlled trial in 21 patients aged 35 +/- 11 y with burns on 45 +/- 16% of their body surface area; 12 had skin biopsies performed on days 3, 10, and 20, and 10 patients underwent a stable-isotope investigation on day 10. Intravenous copper, selenium, and zinc (TE group) or vehicle (V group) was given with a saline solution for 14-21 d. On day 10, [(13)C]phenylalanine (600-microg/kg bolus followed by 12 microg x kg(-1) x min(-1)) plus 6-[(2)H(2)]glucose and [(2)H(5)]glycerol were infused for 6 h to determine skin protein turnover. Biopsies were performed 1 and 6 h after the start of infusion to determine [(13)C]phenylalanine enrichment.
The patients' mean age and burn severity did not differ significantly between the groups nor between the skin investigations subgroups. Plasma TE concentrations were significantly higher in the TE group. In the burned areas, the skin contents of selenium (P=0.02) and zinc (P=0.03) increased by day 20. The supernatant-to-plasma (13)C enrichment ratio in burned skin was 0.363 +/- 0.094 (TE group) and 0.286 +/- 0.130 (V group) after 1 h (NS) and 0.592 +/- 0.153 (TE group) and 0.262 +/- 0.171 (V group) after 6 h, which reflected lower catabolism in the TE group (P=0.03). No significant differences in whole-body substrate turnover were found between the groups.
TE supplementation was associated with an increased skin tissue content of selenium and zinc and with a reduction in skin protein catabolism.
严重烧伤后，患者会出现强烈的分解代谢，伤口需要手术和植皮来闭合。微量元素（TE）缺乏会使体重减轻和伤口愈合延迟等并发症恶化。
我们旨在评估补充TE对严重烧伤后伤口愈合期间全身底物周转和局部蛋白质代谢的影响。
这是一项前瞻性、随机、安慰剂对照试验，纳入了21名年龄在35±11岁、体表面积烧伤45±16%的患者；12名患者在第3、10和20天进行了皮肤活检，10名患者在第10天接受了稳定同位素研究。静脉注射铜、硒和锌（TE组）或赋形剂（V组），并用生理盐水给药14 - 21天。在第10天，静脉输注[(13)C]苯丙氨酸（600μg/kg推注，随后以12μg·kg(-1)·min(-1)）加6-[(2)H(2)]葡萄糖和[(2)H(5)]甘油6小时，以测定皮肤蛋白质周转。在输注开始后1小时和6小时进行活检，以测定[(13)C]苯丙氨酸富集情况。
两组患者的平均年龄和烧伤严重程度无显著差异，皮肤研究亚组之间也无显著差异。TE组血浆TE浓度显著更高。在烧伤区域，到第20天时，硒（P = 0.02）和锌（P = 0.03）的皮肤含量增加。烧伤皮肤中上清液与血浆的(13)C富集比在1小时后为0.363±0.094（TE组）和0.286±0.130（V组）（无显著差异），6小时后为0.592±0.153（TE组）和0.262±0.171（V组），这反映出TE组的分解代谢较低（P = 0.03）。两组之间全身底物周转无显著差异。
补充TE与皮肤组织中硒和锌含量增加以及皮肤蛋白质分解代谢减少有关。
