Vinha Paula Pileggi, Martinez Edson Zangiacomi, Vannucchi Helio, Marchini Julio Sergio, Farina Jayme Adriano, Jordao Alceu Afonso, Cunha Selma Freire
Discipline of Nutrology, Department of Internal Medicine, Ribeirão Preto Medical School, São Paulo University, Brazil.
J Burn Care Res. 2013 Mar-Apr;34(2):e87-91. doi: 10.1097/BCR.0b013e31826fc506.
The objective of this study was to evaluate the vitamin status, inflammatory markers, and oxidative stress markers in adult patients up to 3 days after thermal injury. This prospective study was conducted with 11 patients 24 to 72 hours after thermal injury (Burn Group), total surface area ranging from 10 to 41%, 34.3 ± 9.3 years, 82% of males, body mass index of 22.3 ± 2.9 kg/m(2). We included 11 healthy adults (Control Group), 36.5 ± 7.6 years, 73% of males, and body mass index of 23.8 ± 2.5 kg/m(2). Laboratory data were measured (plasma total protein, albumin, transferrin, lymphocyte counts, zinc, and iron), as well as serum vitamins (folic acid, vitamin B12, and vitamins A, C, and E), inflammatory stress markers (C-reactive protein, ferritin, and acid α1-glycoprotein) and oxidative stress markers such as glutathione peroxidase (GPx) and thiobarbituric acid reactive substances. The inflammatory stress was characterized by lower levels of total protein (median difference 1.2 g/dL, 95% CI: 0.4-2.1) and albumin (median difference 0.9 g/dL, 95% CI: 0.5-1.5), and higher levels of C-reactive protein (median difference -8.12 mg/dL, 95% CI: -11.62 to 4.61) and α-1 glycoprotein acid (median difference -28.56 mg/dL, 95% CI: -51.57 to -5.07) in burn patients. Decreased serum levels of vitamin A (median difference 1.10 μmol/L, 95% confidence interval [CI]: 0.42-1.66) and vitamin C (median difference 0.82 mg/dL, 95% CI: 0.50-1.04) were also detected. There was no statistical evidence of difference in the serum levels of glutathione peroxidase and thiobarbituric acid reactive substances between burn patients and controls, respectively. Even though there is an inflammatory stress, the obtained data showed that oxidative stress markers are normal 24 to 72 hours after burn injury. The decrease in negative acute phase protein may account for the diminished serum levels of vitamin A, which seems to be related to inflammatory stress. The marked decrease in the serum levels of vitamin C can be justified by augmented cutaneous loss and consumption in the regeneration of vitamin E.
本研究的目的是评估热损伤后3天内成年患者的维生素状态、炎症标志物和氧化应激标志物。本前瞻性研究对11例热损伤后24至72小时的患者（烧伤组）进行，烧伤总面积为10%至41%，年龄34.3±9.3岁，男性占82%，体重指数为22.3±2.9kg/m²。我们纳入了11名健康成年人（对照组），年龄36.5±7.6岁，男性占73%，体重指数为23.8±2.5kg/m²。检测了实验室数据（血浆总蛋白、白蛋白、转铁蛋白、淋巴细胞计数、锌和铁），以及血清维生素（叶酸、维生素B12、维生素A、C和E）、炎症应激标志物（C反应蛋白、铁蛋白和酸性α1-糖蛋白）和氧化应激标志物，如谷胱甘肽过氧化物酶（GPx）和硫代巴比妥酸反应性物质。炎症应激的特征是烧伤患者的总蛋白水平较低（中位数差异1.2g/dL，95%CI：0.4-2.1）和白蛋白水平较低（中位数差异0.9g/dL，95%CI：0.5-1.5），以及C反应蛋白水平较高（中位数差异-8.12mg/dL，95%CI：-11.62至4.61）和α-1糖蛋白酸水平较高（中位数差异-28.56mg/dL，95%CI：-51.57至-5.07）。还检测到血清维生素A水平降低（中位数差异1.10μmol/L，95%置信区间[CI]：0.42-1.66）和维生素C水平降低（中位数差异0.82mg/dL，95%CI：0.50-1.04）。烧伤患者与对照组之间谷胱甘肽过氧化物酶和硫代巴比妥酸反应性物质的血清水平分别无统计学差异。尽管存在炎症应激，但获得的数据表明，烧伤后24至72小时氧化应激标志物正常。负急性期蛋白的降低可能是血清维生素A水平降低的原因，这似乎与炎症应激有关。血清维生素C水平的显著降低可以通过皮肤损失增加和维生素E再生过程中的消耗来解释。
