Pediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon-Bron, France.
Department of Biochemistry, Lyon Sud Hospital, Laboratoire d'Analyse de Traces et Métaux Toxiques, Hospices Civils de Lyon, Lyon, France.
Pediatr Crit Care Med. 2018 Sep;19(9):e455-e463. doi: 10.1097/PCC.0000000000001626.
Micronutrient supplementation in critically ill adults remains controversial. In the pediatric setting, the impact of oxidative stress on the overall micronutrient status has been poorly explored, due to the limited number of studies and to confounding factors (i.e., malnutrition or extra losses). In order to better understand this phenomenon, we aim to describe micronutrient status, focusing on seven micronutrients, in well-nourished critically ill children presenting with severe oxidative stress.
Prospective, transversal, observational, single-center study.
PICU, and anesthesiology department, Lyon, France.
Three groups of patients were clinically defined: severe oxidative stress PICU group (at least two organ dysfunctions), moderate oxidative stress PICU group (single organ dysfunction), and healthy control group (prior to elective surgery); oxidative stress intensity was controlled by measuring plasma levels of glutathione peroxidase and glutathione. Children presenting any former condition leading to micronutrient deficiency were excluded (malnutrition, external losses).
Plasma levels of selenium, zinc, copper, vitamin A, vitamin E, vitamin C, and β-carotene were measured in PICU oxidative stress conditions and compared with those of healthy children.
Two hundred one patients were enrolled (51, 48, and 102 in severe, moderate, and healthy control groups, respectively). Median age was 7.1 years (interquartile range, 2.1-13.8 yr). There was a significant trend (p < 0.02) toward plasma level decrease of six micronutrients (selenium, zinc, copper, vitamin E, vitamin C, and β-carotene) while oxidative stress intensity increased. Biological markers of oxidative stress (glutathione peroxidase and glutathione) were in accordance with the clinical definition of the three groups.
A multiple micronutrient deficiency or redistribution occurs in critically ill children presenting with severe oxidative stress. These findings will help to better identify children who might benefit from micronutrient supplementation and to design adapted supplementation trials in this particular setting.
危重症成人的微量营养素补充仍存在争议。在儿科领域，由于研究数量有限且存在混杂因素（即营养不良或额外损失），氧化应激对整体微量营养素状态的影响仍未得到充分探索。为了更好地了解这一现象，我们旨在描述营养良好的危重症儿童中发生严重氧化应激时的七种微量营养素的状况。
前瞻性、横断、观察性、单中心研究。
法国里昂的儿科重症监护病房（PICU）和麻醉科。
根据临床定义，患者分为三组：严重氧化应激 PICU 组（至少存在两个器官功能障碍）、中度氧化应激 PICU 组（单个器官功能障碍）和健康对照组（择期手术前）；通过测量血浆谷胱甘肽过氧化物酶和谷胱甘肽的水平来控制氧化应激的强度。排除了任何导致微量营养素缺乏的既往疾病的患者（营养不良、外部损失）。
测量 PICU 氧化应激条件下的血浆硒、锌、铜、维生素 A、维生素 E、维生素 C 和β-胡萝卜素水平，并与健康儿童进行比较。
共纳入 201 例患者（分别为严重、中度和健康对照组各 51、48 和 102 例）。中位年龄为 7.1 岁（四分位距，2.1-13.8 岁）。随着氧化应激强度的增加，六种微量营养素（硒、锌、铜、维生素 E、维生素 C 和β-胡萝卜素）的血浆水平呈显著下降趋势（p < 0.02）。氧化应激的生物标志物（谷胱甘肽过氧化物酶和谷胱甘肽）与三组的临床定义相符。
在出现严重氧化应激的危重症儿童中，存在多种微量营养素缺乏或重新分布。这些发现将有助于更好地识别可能受益于微量营养素补充的儿童，并在这种特殊情况下设计适当的补充试验。
