Cunningham J J, Lydon M K, Briggs S E, DeCheke M
Nutritional Support Unit, Shiners Burns Institute, Boston, Massachusetts 02114.
J Am Coll Nutr. 1991 Feb;10(1):57-62. doi: 10.1080/07315724.1991.10718127.
Alterations in zinc (Zn) and copper (Cu) homeostasis have been reported during the acute recovery period following thermal injury in both children and adults. Increased urinary losses of Zn and Cu and decreased plasma concentrations of Zn, Cu, and ceruloplasmin (CP), the major copper transport protein, occur despite adequate provision of these elements in enteral feedings. We now report data for moderately to severely burned children receiving total parenteral nutrition (TPN) supplemented to provide Zn and Cu. Hyperzincuria occurred consistently when 50 micrograms/kg Zn was delivered daily to older children. Similarly, when younger children received 100 micrograms/kg Zn daily, profound hyperzincuria ensued despite a reduction in total plasma Zn. Hypozincemia was accompanied by low levels of Zn in the plasma subfraction normally associated with albumin-bound Zn. The delivery of Cu via TPN was 4-12 micrograms/kg daily, and urinary Cu losses were not elevated. Plasma total Cu and plasma CP were invariably reduced. These findings are discussed in relation to guidelines published for pediatric trace element supplementation during TPN.
据报道，儿童和成人热损伤后的急性恢复期会出现锌（Zn）和铜（Cu）体内稳态的改变。尽管肠内营养中已充分提供这些元素，但仍会出现锌和铜的尿排泄增加，以及血浆中锌、铜和主要铜转运蛋白铜蓝蛋白（CP）的浓度降低。我们现在报告中度至重度烧伤儿童接受补充锌和铜的全胃肠外营养（TPN）的数据。当每日给大龄儿童输注50微克/千克锌时，持续性高锌尿症会持续出现。同样，当小龄儿童每日接受100微克/千克锌时，尽管血浆总锌含量降低，但仍会出现严重的高锌尿症。低锌血症伴随着血浆中通常与白蛋白结合锌相关的亚组分锌含量降低。通过TPN每日输注的铜为4 - 12微克/千克，尿铜排泄未增加。血浆总铜和血浆铜蓝蛋白始终降低。结合TPN期间儿科微量元素补充的相关指南对这些发现进行了讨论。
