Rehou Sarah, Shahrokhi Shahriar, Natanson Rimona, Stanojcic Mile, Jeschke Marc G
Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Ontario, Canada.
J Burn Care Res. 2018 Jan 1;39(1):1-9. doi: 10.1097/BCR.0000000000000607.
Oxidative stress after burn injury induces inflammatory and hypermetabolic responses associated with adverse outcomes. We propose that antioxidant and trace element supplementation may reduce oxidative stress and subsequently alleviate inflammation and hypermetabolism, thus improving clinical outcomes. We conducted a cohort study of adult patients with an acute burn injury admitted to our provincial burn center. Patients in the antioxidant group received an intravenous infusion of multivitamins and trace elements for the first 14 days after admission. The inflammatory profile was assessed at early time points, < 14 days postburn, and later time points, ≥ 15 days postburn, and included interleukin (IL)-1β, interferon-γ, IL-1 receptor antagonist, IL-6, granulocyte-macrophage colony-stimulating factor, and FMS-like tyrosine kinase 3 ligand. Hypermetabolism was assessed by resting energy expenditure. Clinical outcomes included mortality, morbidities, hospital length of stay, and infections including days to the last positive culture after injury. We studied 172 patients, mean age 49 ± 17 years and 33 ± 13% TBSA burned, with 91 controls and 81 patients in the antioxidant group. Patients in the antioxidant group had significantly lower levels of inflammatory markers at both early and late time points, P < .05. Antioxidant treatment was associated with decreased measure of hypermetabolism, P < .05. Morbidity and mortality were not significantly different between groups. Length of hospital stay was significantly shorter in the antioxidant group when adjusted for patient demographics and injury characteristics (risk ratio (RR), 0.78; 95% confidence interval (CI), 0.66-0.92). In the antioxidant group, while infections were not different, the last positive culture post-injury was documented at median 19 days (Interquartile range (IQR), 11-43 days) compared with controls at 35 days (IQR, 15-59 days), P = .012. Patients receiving antioxidant and trace element supplementation had reduced markers of burn stress-induced inflammation; they were also associated with a decreased hypermetabolic response, shorter length of stay, and improved bacterial clearance.
烧伤后的氧化应激会引发炎症和高代谢反应，这些反应与不良预后相关。我们提出，补充抗氧化剂和微量元素可能会减轻氧化应激，进而缓解炎症和高代谢状态，从而改善临床结局。我们对入住省级烧伤中心的成年急性烧伤患者进行了一项队列研究。抗氧化剂组的患者在入院后的前14天接受静脉输注多种维生素和微量元素。在烧伤后<14天的早期时间点和≥15天的后期时间点评估炎症指标，包括白细胞介素（IL）-1β、干扰素-γ、IL-1受体拮抗剂、IL-6、粒细胞-巨噬细胞集落刺激因子和FMS样酪氨酸激酶3配体。通过静息能量消耗评估高代谢状态。临床结局包括死亡率、发病率、住院时间以及感染情况，感染情况包括受伤后最后一次阳性培养的天数。我们研究了172例患者，平均年龄49±17岁，烧伤总面积为33±13%TBSA，其中91例为对照组，81例为抗氧化剂组患者。抗氧化剂组患者在早期和后期时间点的炎症标志物水平均显著较低，P<.05。抗氧化剂治疗与高代谢指标的降低相关，P<.05。两组之间的发病率和死亡率无显著差异。在根据患者人口统计学和损伤特征进行调整后，抗氧化剂组的住院时间显著缩短（风险比（RR），0.78；95%置信区间（CI），0.66-0.92）。在抗氧化剂组中，虽然感染情况没有差异，但受伤后最后一次阳性培养记录的中位数为19天（四分位间距（IQR），11-43天），而对照组为35天（IQR，15-59天），P=.012。接受抗氧化剂和微量元素补充的患者烧伤应激诱导的炎症标志物减少；它们还与高代谢反应降低、住院时间缩短和细菌清除改善有关。
