The McComb Research Foundation, Telstra Burn Outcome Centre, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia.
Burns. 2010 Mar;36(2):261-9. doi: 10.1016/j.burns.2009.04.012. Epub 2009 Jun 6.
The importance of vitamins for optimal metabolism is well established. However, currently little is known about the optimal vitamin levels required for burn patients. As a consequence, current practice both for macronutrient supplementation and vitamin supplementation varies widely between burn units. A better understanding of the effects of vitamins on metabolism may lead to better nutrition and subsequently improved outcomes for burn patients. Thiamine is an important co-factor required for multiple enzymes involved in carbohydrate metabolism. We have examined the levels of thiamine (B1) in burn patients as well as the effects of thiamine supplementation on the levels of serum thiamine, pyruvate and lactate. Twenty patients had blood samples taken on the day of admission, then on days 1, 3, and 7 post-admission and weekly thereafter until discharge. Of these, nine received enteral feeding. Six patients received thiamine supplementation. Serum thiamine, pyruvate and lactate levels were measured at each time point. Serum thiamine levels increased significantly with thiamine supplementation (p<0.001). Serum thiamine levels also increased with time of supplementation (p<0.001). Serum thiamine level was closely associated with pyruvate and lactate levels, with a decrease in both pyruvate and lactate associated with increased serum thiamine. Lastly, pyruvate and lactate levels appear closely associated in a linear relationship. This study suggests thiamine supplementation increases serum thiamine and that this increase is associated with a decrease in pyruvate and lactate levels. Further study of changes in metabolic flux associated with thiamine supplementation and a randomised control trial of thiamine supplementation are required to establish whether thiamine supplementation is beneficial to burn patients' metabolism and recovery.
维生素对最佳新陈代谢的重要性已得到充分证实。然而，目前对于烧伤患者所需的最佳维生素水平知之甚少。因此，目前各大烧伤科单位在给予宏量营养素补充和维生素补充方面存在很大差异。更好地了解维生素对新陈代谢的影响可能会导致更好的营养，进而改善烧伤患者的预后。硫胺素是参与碳水化合物代谢的多种酶所必需的重要辅酶。我们研究了烧伤患者的硫胺素（B1）水平以及硫胺素补充对血清硫胺素、丙酮酸和乳酸水平的影响。20 名患者在入院当天、入院后第 1、3 和 7 天以及此后每周直至出院时采集血样。其中 9 名接受肠内喂养。6 名患者接受硫胺素补充。在每个时间点测量血清硫胺素、丙酮酸和乳酸水平。硫胺素补充后血清硫胺素水平显著升高（p<0.001）。随着补充时间的延长，血清硫胺素水平也逐渐升高（p<0.001）。血清硫胺素水平与丙酮酸和乳酸水平密切相关，随着血清硫胺素水平升高，丙酮酸和乳酸水平均降低。最后，丙酮酸和乳酸水平呈线性相关。这项研究表明，硫胺素补充可增加血清硫胺素，且这种增加与丙酮酸和乳酸水平降低有关。需要进一步研究硫胺素补充与代谢通量变化之间的关系，并开展硫胺素补充的随机对照试验，以确定硫胺素补充是否有益于烧伤患者的代谢和康复。
