Cunningham J J, Leffell M, Harmatz P
Nutritional Support Unit, Shriners Burns Institute, Boston, MA 02114.
Nutrition. 1993 Jul-Aug;9(4):329-32.
Copper (Cu) is an essential nutrient with known metabolic roles in wound healing. Ceruloplasmin (CP), the primary Cu-transport protein, responds as an acute-phase reactive protein after trauma. However, for severe burn trauma, this response is absent in the early catabolic phase despite Cu provision. We report data for 14 severely burned children receiving Cu in total parenteral nutrition (TPN-Cu) ranging from 7 to 26 micrograms Cu.kg-1 x day-1. All patients manifested low plasma levels of CP. The reduction in CP reflected burn severity but also appeared to be dependent on the Cu dose. Increasing Cu supplementation to improve CP raises a concern for hepatotoxicity, which is accompanied by an elevation in the plasma nonceruloplasmin Cu (nonCP-Cu). The calculated plasma nonCP-Cu in our series is consistent with a lack of increased risk and suggests that TPN-Cu at the general pediatric guideline of 20 micrograms.kg-1 x day-1 is safe and reasonable for severely burned children. Cu supplementation > 20 micrograms/kg may be beneficial; however, monitoring of both CP and total Cu should continue as standard practice in the management of these patients.
铜（Cu）是一种必需营养素，在伤口愈合中具有已知的代谢作用。铜蓝蛋白（CP）是主要的铜转运蛋白，在创伤后作为急性期反应蛋白发挥作用。然而，对于严重烧伤创伤，尽管补充了铜，但在早期分解代谢阶段这种反应并不存在。我们报告了14名接受全胃肠外营养铜（TPN-Cu）的严重烧伤儿童的数据，铜剂量为7至26微克/千克·天。所有患者血浆CP水平均较低。CP的降低反映了烧伤的严重程度，但似乎也取决于铜的剂量。增加铜补充量以提高CP会引发对肝毒性的担忧，这伴随着血浆非铜蓝蛋白铜（nonCP-Cu）的升高。我们系列中计算出的血浆nonCP-Cu与风险增加无关，表明按照20微克/千克·天的一般儿科指南给予TPN-Cu对严重烧伤儿童是安全合理的。补充铜>20微克/千克可能有益；然而，在这些患者的管理中，应继续按照标准做法监测CP和总铜。
