Tuuminen Tamara, Sorsa Mikko, Tornudd Martin, Poussa Tuija, Antila Erkki, Jaakkola Kaarlo
Medical Center Kruunuhaka Oy, Kaisanimenkatu 1Ba, Helsinki, Finland; Mineraalilaboratorio Mila Oy, Helsinki, Finland.
Mineraalilaboratorio Mila Oy, Helsinki, Finland; Solu Digital Oy, Helsinki, Finland.
Clin Nutr ESPEN. 2019 Oct;33:283-289. doi: 10.1016/j.clnesp.2019.06.011. Epub 2019 Jul 3.
Low-grade chronic inflammation is a condition underlying many serious diseases but there is no good single biomarker which can estimate and monitor the severity of the inflammation. C-reactive protein (CRP) is the best validated and most extensively used marker. The aims of the study were to investigate the extent to which CRP levels associate with levels of micronutrients.
We retrieved the levels of S-hsCRP and nutritional variables fB-β-carotenes, fS-Q10 (Ubiquinon), fS-Fe, E-Cu, fS-A vitamin, B-Se, B-Zn, and fB-B12 vitamin from the database of clinical laboratory Mila Oy from the years 1988-2018, a total of nearly 18 800 samples from outpatient clinics, Helsinki and Oulu, Finland. Sample sizes for nutritional variables measured concurrently with S-hsCRP varied between 4356 and 8621. S-hsCRP levels were categorized into five ordered categories. The levels of each micronutrient in those categories were compared using analysis of variance (ANOVA). Males and females were analyzed separately.
It was observed that an increase of S-hsCRP associated with the decrease of fS-Fe (p < 0.001 for both genders); fS-A vitamin (p < 0.001 for both genders), and fS-β-carotenes (p < 0.001 for both genders); these are considered negative acute phase reactants. For both genders there was no significant association between the levels of fS-B12 vitamin (p = 0.14 for males; p = 0.03 for females), fS-Q10 (p < 0.001 for males; p = 0.06 for females) and fB-Se (p < 0.001 for males; p = 0.01 for females) and the categorized S-hsCRP. In contrast, fB-Zn (p < 0.001 for both genders) behaved like a positive acute phase reactant whereas copper measured from washed blood cells (E-Cu) did not display any significant associations with S-hsCRP (p = 0.001 for males; p = 0.05 for females).
A linear association was observed for some micronutrients - the higher the degree of low-grade inflammation (S-hsCRP), the more disturbed were the levels of some micronutrients. For clinicians, this finding means that inflammation needs to be acknowledged when assessing micronutrient deficiency. Substitution therapy should be implemented only after the inflammation has been rectified.
低度慢性炎症是许多严重疾病的潜在病因，但目前尚无良好的单一生物标志物可用于评估和监测炎症的严重程度。C反应蛋白（CRP）是经过最佳验证且使用最广泛的标志物。本研究的目的是调查CRP水平与微量营养素水平之间的关联程度。
我们从芬兰赫尔辛基和奥卢门诊临床实验室米拉有限公司（Mila Oy）1988年至2018年的数据库中检索了超敏C反应蛋白（S-hsCRP）水平以及营养变量，包括游离β-胡萝卜素（fB-β-carotenes）、游离辅酶Q10（fS-Q10，泛醌）、游离铁（fS-Fe）、红细胞铜（E-Cu）、游离维生素A（fS-A vitamin）、维生素B12（B-B12 vitamin）和硒（B-Se）、锌（fB-Zn），共近18800份样本。与S-hsCRP同时测量的营养变量样本量在4356至8621之间。S-hsCRP水平分为五个有序类别。使用方差分析（ANOVA）比较这些类别中每种微量营养素的水平。男性和女性分别进行分析。
观察到S-hsCRP升高与游离铁（fS-Fe）水平降低相关（男女p均<0.001）；游离维生素A（fS-A vitamin）水平降低（男女p均<0.001），以及游离β-胡萝卜素水平降低（男女p均<0.001）；这些被认为是负急性期反应物。对于男女而言，游离维生素B12水平（男性p = 0.14；女性p = 0.03）、游离辅酶Q10（男性p < 0.001；女性p = 0.06）和硒（男性p < 0.001；女性p = 0.01）与分类后的S-hsCRP之间均无显著关联。相比之下，锌（fB-Zn）（男女p均<0.001）表现为正急性期反应物，而从洗涤后的血细胞中测得的铜（E-Cu）与S-hsCRP无任何显著关联（男性p = 0.001；女性p = 0.05）。
观察到某些微量营养素存在线性关联——低度炎症（S-hsCRP）程度越高，某些微量营养素水平受干扰越大。对于临床医生而言，这一发现意味着在评估微量营养素缺乏时需要考虑炎症因素。仅在炎症得到纠正后才可实施替代疗法。
