St Mark's Hospital, Watford Road, Harrow, HA1 3UJ, United Kingdom.
Clin Nutr ESPEN. 2023 Oct;57:676-682. doi: 10.1016/j.clnesp.2023.08.004. Epub 2023 Aug 5.
BACKGROUND & AIMS: Patients with chronic intestinal failure require HPN. Previous studies have reported a high prevalence of micronutrient deficiencies. We examined the micronutrient status of our patients receiving.
We measured vitamins A, E, D, B12, Folate, Zinc, Selenium and Copper. Patients were excluded if they had undergone surgery or amendments in IV or oral micronutrient provision in the past six months. Blood samples were excluded if C-reactive protein was >15 mg/L. Univariate and multivariate analyses were performed on concentrations below normal to determine if clinical or demographic categories were significant.
93 samples were included (33 males:60 females). Samples were excluded due to surgery (n = 8) amendment in micronutrient provision (n = 42) or if C-reactive protein >15 mg/L (n = 18). Vitamins A, D and E were below normal in 26%, 33% and 13% of patients respectively. Lower vitamin A was more likely in patients >50 years (P = 0.02) and lower vitamin E was more likely in men (P = 0.02). No patients had low vitamin B12 or folate whereas 29% and 9% had concentrations above the normal range respectively. Zinc and selenium were below normal in 19% and 13% respectively. Patients with surgical complications were more likely to have lower zinc (P = 0.007) and selenium (P = 0.04). Lower zinc was more likely in patients with a BMI of >25 kg/m (P = 0.01) and those who received Additrace® ≤3 day/week (P = 0.06).
Low and high concentrations were observed in our patients but clinical and demographic factors did not impact consistently on micronutrient concentrations highlighting the importance of ongoing monitoring and adequate supplementation as per ESPEN guidelines. Current micronutrient preparations may be inadequate for some patients with dependent on HPN. Our results indicate a need for a preparation with higher amounts of vitamin D.
慢性肠衰竭患者需要接受 HPN。既往研究报道了大量微量营养素缺乏症的患病率。我们检测了正在接受 HPN 的患者的微量营养素状态。
我们检测了维生素 A、E、D、B12、叶酸、锌、硒和铜。如果患者在过去 6 个月内进行过手术或 IV 或口服补充微量营养素，将被排除。如果 C-反应蛋白 >15mg/L，则排除血样。对浓度低于正常值的患者进行单变量和多变量分析，以确定临床或人口统计学类别是否具有显著意义。
共纳入 93 例样本（男 33 例，女 60 例）。由于手术（n=8）、微量营养素供给修订（n=42）或 C-反应蛋白 >15mg/L（n=18），排除了 8 例样本和 42 例样本。分别有 26%、33%和 13%的患者维生素 A、D 和 E 浓度低于正常值。>50 岁的患者更可能出现维生素 A 降低（P=0.02），男性更可能出现维生素 E 降低（P=0.02）。没有患者出现维生素 B12 或叶酸缺乏，但分别有 29%和 9%的患者浓度高于正常值。锌和硒分别有 19%和 13%低于正常值。有手术并发症的患者更可能出现锌（P=0.007）和硒（P=0.04）降低。BMI>25kg/m2 的患者（P=0.01）和每周接受 Additrace®≤3 天的患者（P=0.06）更可能出现锌降低。
我们的患者存在高低浓度的微量营养素，但临床和人口统计学因素并没有一致地影响微量营养素浓度，这突显了根据 ESPEN 指南持续监测和充分补充的重要性。目前的微量营养素制剂可能不适合所有依赖 HPN 的患者。我们的结果表明，需要一种含有更高剂量维生素 D 的制剂。
