Department of Physiology, Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, Health Campus, University of Granada, 18071, Granada, Spain; Moorfields Eye Hospital, NHS, London, EC1 V2PD, United Kingdom.
Department of Physiology, Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, Health Campus, University of Granada, 18071, Granada, Spain.
J Trace Elem Med Biol. 2018 Sep;49:202-209. doi: 10.1016/j.jtemb.2017.11.013. Epub 2017 Nov 26.
Critically ill patients develop severe stress, inflammation and a clinical state that may raise the utilization and metabolic replacement of many nutrients and especially zinc, depleting their body reserves. This study was designed to assess the zinc status in critical care patients with systemic inflammatory response syndrome (SIRS), comparing them with a group of healthy people, and studying the association with expression of zinc transporters.
This investigation was a prospective, multicentre, comparative, observational and analytic study. Twelve critically ill patients from different hospitals and 12 healthy subjects from Granada, Spain, all with informed consent were recruited. Data on daily nutritional assessment, ICU severity scores, inflammation, clinical and nutritional parameters, plasma and blood cell zinc concentrations, and levels of transcripts for zinc transporters in whole blood were taken at admission and at the seventh day of the ICU stay.
Zinc levels on critical ill patient are diminish comparing with the healthy control (HS: 0.94 ± 0.19; CIPF: 0.67 ± 0.16 mg/dL). The 58% of critical ill patients showed zinc plasma deficiency at beginning of study while 50.0% of critical ill after 7 days of ICU stay. ZnT7, ZIP4 and ZIP9 were the zinc transporters with highest expression in whole blood. In general, all zinc transporters were significantly down-regulated (P < 0.05) in the critical ill population at admission in comparison with healthy subjects. Severity scores and inflammation were significantly associated (P < 0.05) with zinc plasma levels, and zinc transporters ZIP3, ZIP4, ZIP8, ZnT6, ZnT7. Expression of 11 out of 24 zinc transporters was analysed, and ZnT1, ZnT4, ZnT5 and ZIP4, which were downregulated by more than 3-fold in whole blood of patients.
In summary, in our study an alteration of zinc status was related with the severity-of-illness scores and inflammation in critical ill patients since admission in ICU stay. SIRS caused a general shut-down of expression of zinc transporters in whole blood. That behavior was associated with severity and inflammation of patients at ICU admission regardless zinc status. We conclude that zinc transporters in blood might be useful indicators of severity of systemic inflammation and outcome for critically ill patients.
危重症患者会出现严重的应激、炎症和临床状态，这可能会增加许多营养素（尤其是锌）的利用和代谢替代，从而耗尽其体内储备。本研究旨在评估全身性炎症反应综合征（SIRS）的重症监护患者的锌状态，将其与一组健康人群进行比较，并研究其与锌转运体表达的关系。
这是一项前瞻性、多中心、对照、观察性和分析性研究。从不同医院招募了 12 名危重症患者和 12 名来自西班牙格拉纳达的健康志愿者，均获得了知情同意。在入院时和入住 ICU 后的第 7 天，收集了每日营养评估、ICU 严重程度评分、炎症、临床和营养参数、血浆和血细胞锌浓度以及全血中锌转运体转录水平的数据。
与健康对照组相比（HS：0.94±0.19；CIPF：0.67±0.16mg/dL），危重症患者的锌水平降低。研究开始时，58%的危重症患者出现锌血浆缺乏，而 7 天后的危重症患者中有 50.0%出现锌血浆缺乏。ZnT7、ZIP4 和 ZIP9 是全血中表达最高的锌转运体。一般来说，与健康对照组相比，所有锌转运体在危重症患者入院时均显著下调（P<0.05）。严重程度评分和炎症与锌血浆水平显著相关（P<0.05），与锌转运体 ZIP3、ZIP4、ZIP8、ZnT6、ZnT7 相关。分析了 24 种锌转运体中的 11 种，其中 ZnT1、ZnT4、ZnT5 和 ZIP4 在患者全血中的表达下调了 3 倍以上。
综上所述，在我们的研究中，危重症患者在入住 ICU 期间，锌状态的改变与疾病严重程度评分和炎症有关。SIRS 导致全血中锌转运体的表达普遍关闭。这种行为与患者在入住 ICU 时的严重程度和炎症有关，而与锌状态无关。我们得出结论，血液中的锌转运体可能是危重症患者全身炎症严重程度和预后的有用指标。
