Department of Gastroenterology and Nutritional Support, Beaujon Hospital, Assistance Publique des Hôpitaux de Paris, Université Paris VII, Clichy, France.
Department of Gastroenterology, Saint-Antoine Hospital, Assistance Publique des Hôpitaux de Paris, Université Paris VI, Paris, France.
Clin Nutr. 2017 Jun;36(3):812-817. doi: 10.1016/j.clnu.2016.05.008. Epub 2016 May 23.
Antioxidants essential trace elements (TEs), selenium (Se), zinc (Zn) and copper (Cu) are key dietary components and their supplementation in parenteral nutrition (PN) is recommended. However, the frequency of marginal deficiencies and related clinical outcomes remain poorly known in patients receiving long-term PN.
We conducted a retrospective observational study whose aim was to determine in a cohort of patients (n = 73) with chronic intestinal failure (CIF) enrolled in a tertiary home PN center and receiving long-term PN with systematic multi-TE supplementation, the prevalence of low serum TEs levels. The goal was also to assess mid-term incidence of serious infection and its associated factors.
Among the 73 studied patients, 21.9%, 13.9% and 21.1% had low serum Se (<0.9 μmol/l), Cu (<12.7 μmol/l) and Zn (<12.5 μmol/l) levels, respectively. There was no difference between short bowel syndrome (SBS) and non-SBS patients. 30 patients had at least one of the three serum TEs levels under the cut-off values of deficiency. No specific disease and/or underlying intestinal anatomy were associated with low serum TEs concentration. Cumulative incidence rates of serious infection were 11.1% 95CI[5.7-21.0] and 19.5% 95CI[12.0-30.7] at 6 months and 1 year, respectively. Central venous catheter-related bloodstream infection was the most common infection. Low serum Se was independently associated with a higher risk to develop serious infection (HR 2.65 95CI[1.01-6.97]).
Low serum TEs concentration is a frequent condition in patients with CIF even with systematic multi-TE supplementations. Se deficiency exposes to a greater risk of serious infection. This suggests that frequent TEs dosage in this population as well as individually tailored supplementation may be beneficial.
抗氧化剂、必需微量元素（TEs）、硒（Se）、锌（Zn）和铜（Cu）是关键的膳食成分，其在肠外营养（PN）中的补充已得到推荐。然而，在接受长期 PN 治疗的患者中，边缘缺乏的频率及其相关临床结局仍知之甚少。
我们进行了一项回顾性观察性研究，目的是在一个长期接受 PN 治疗且系统补充多种 TE 的三级家庭 PN 中心的慢性肠衰竭（CIF）患者队列（n=73）中，确定低血清 TEs 水平的患病率。还评估了中期严重感染的发生率及其相关因素。
在 73 名研究患者中，分别有 21.9%、13.9%和 21.1%的患者血清 Se（<0.9 μmol/L）、Cu（<12.7 μmol/L）和 Zn（<12.5 μmol/L）水平较低。短肠综合征（SBS）和非-SBS 患者之间没有差异。30 名患者至少有一种血清 TE 水平低于缺乏的临界值。没有特定的疾病和/或潜在的肠道解剖结构与低血清 TE 浓度相关。严重感染的累积发生率分别为 6 个月和 1 年时的 11.1%（95%CI[5.7-21.0]）和 19.5%（95%CI[12.0-30.7]）。中心静脉导管相关血流感染是最常见的感染。低血清 Se 与发生严重感染的风险增加独立相关（HR 2.65 95%CI[1.01-6.97]）。
即使进行了系统的多种 TE 补充，CIF 患者仍常出现低血清 TE 浓度。Se 缺乏使严重感染的风险增加。这表明在该人群中经常进行 TE 检测以及个体化补充可能是有益的。
