Berger M M, Spertini F, Shenkin A, Wardle C, Wiesner L, Schindler C, Chiolero R L
Surgical ICU and Burns Centre, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Am J Clin Nutr. 1998 Aug;68(2):365-71. doi: 10.1093/ajcn/68.2.365.
Infections remain the leading cause of death after major burns. Trace elements are involved in immunity and burn patients suffer acute trace element depletion after injury. In a previous nonrandomized study, trace element supplementation was associated with increased leukocyte counts and shortened hospital stays. This randomized, placebo-controlled trial studied clinical and immune effects of trace element supplements. Twenty patients, aged 40 +/- 16 y (mean +/- SD), burned on 48 +/- 17% of their body surfaces, were studied for 30 d after injury. They consumed either standard trace element intakes plus supplements (40.4 micromol Cu, 2.9 micromol Se, and 406 micromol Zn; group TE) or standard trace element intakes plus placebo (20 micromol Cu, 0.4 micromol Se, and 100 micromol Zn; group C) for 8 d. Demographic data were similar for both groups. Mean plasma copper and zinc concentrations were below normal until days 20 and 15, respectively (NS). Plasma selenium remained normal for group TE but decreased for group C (P < 0.05 on days 1 and 5). Total leukocyte counts tended to be higher in group TE because of higher neutrophil counts. Proliferation to mitogens was depressed compared with healthy control subjects (NS). The number of infections per patient was significantly (P < 0.05) lower in group TE (1.9 +/- 0.9) than in group C (3.1 +/- 1.1) because of fewer pulmonary infections. Early trace element supplementation appears beneficial after major burns; it was associated with a significant decrease in the number of bronchopneumonia infections and with a shorter hospital stay when data were normalized for burn size.
感染仍然是严重烧伤后主要的死亡原因。微量元素参与免疫反应，烧伤患者在受伤后会出现急性微量元素缺乏。在之前一项非随机研究中，补充微量元素与白细胞计数增加和住院时间缩短有关。这项随机、安慰剂对照试验研究了微量元素补充剂的临床和免疫效果。研究了20名年龄为40±16岁（平均±标准差）、体表面积烧伤48±17%的患者，在受伤后30天内进行观察。他们在8天内分别摄入标准微量元素摄入量加补充剂（40.4微摩尔铜、2.9微摩尔硒和406微摩尔锌；TE组）或标准微量元素摄入量加安慰剂（20微摩尔铜、0.4微摩尔硒和100微摩尔锌；C组）。两组的人口统计学数据相似。平均血浆铜和锌浓度分别在第20天和第15天之前低于正常水平（无显著性差异）。TE组的血浆硒保持正常，而C组则下降（第1天和第5天P<0.05）。由于中性粒细胞计数较高，TE组的总白细胞计数往往更高。与健康对照受试者相比，对有丝分裂原的增殖受到抑制（无显著性差异）。由于肺部感染较少，TE组（1.9±0.9）每位患者的感染次数显著低于C组（3.1±1.1）（P<0.05）。严重烧伤后早期补充微量元素似乎有益；当对烧伤面积进行数据标准化时，它与支气管肺炎感染次数的显著减少以及住院时间缩短有关。
