体外循环围术期血清cTnT、hs-CRP和补体C3、C4水平变化的意义

目的探讨在体外循环(CPB)下心脏手术围术期动态检测血清心肌肌钙蛋白T(cTnT)、超敏C反应蛋白(hs-CRP)和补体(C)C3、C4水平变化的意义。方法选择20例进行CPB手术和10例非CPB手术围术期中几个时期的血液(包括术前、术后即刻、24 h、48 h和72 h),测定其血清cTnT、hs-CRP和C3、C4的水平。结果术前cTnT、hs-CRP和C3、C4水平均在正常范围内。CPB组患者cTnT以术后即刻显著增高[(0.64±0.18)ng/ml vs(0.09±0.11)ng/ml,P<0.01)],术后24 h后开始下降至72 h后趋于正常;hs-CRP于术后24 h开始显著增高[(16.40±1.71)mg/Lvs(1.57±3.62)mg/L,P<0.01)],至72 h后逐渐降低;C3水平在术后即刻显著低于术前[(0.67±0.29)g/L vs(1.36±0.61)g/L,P<0.01)],术后48 h恢复并显著高于术前水平;C4水平在术后即刻显著低于术前[(0.14±0.07)g/L vs(0.27±0.16)g/L,P<0.01)],术后72 h恢复并显著高于术前水平;对照组hs-CRP术后24 h增高,至术后72 h后逐渐降低(P<0.01),其他各项指标较术前差异均无统计学意义(P>0.05)。结论cTnT、hs-CRP和C3、C4水平能反映CPB围术期心肌细胞的损害程度和机体免疫状态。     

Interaction between cytokines, nutrition and infection

Present evidence suggests that cytokines, as intercellular mediators, play a key role in the nutrition-infection complex. Protein-calorie malnutrition, deficiency of fatty acids, vitamins, trace elements, impair cytokine production. By the other hand, infections increase pro-inflammatory cytokine production interfering with nutritional status by impairing metabolic activity and by inducing anorexia. Elevated cytokine levels in human milk represent a physiological phenomenon and is not necessarily associated to infectious processes. Research on the kinetical behaviour of pro-inflammatory cytokine in each of the above mentioned conditions should be performed as a goal for future investigations. The development of comprehensive studies on the influence of dietary supplementation on cytokine production could be of clinical interest. However, the results obtained should be considered with caution because cytokines are highly interdependent and changes in some of them could affect target tissue. For instance dietary supplementation with (n-3) polyunsaturated fatty acids (PUFA), generally recommended in elderly subjects for reducing or preventing inflammatory diseases, down-regulate cytokine production, but secondarily suppress cell-mediated immune response, effect that may not be desirable. When evaluating cytokine production during dietary supplementation programs is important to consider food consumption, age, presence of infection and/or stress. Future clinical trials are needed to define the diet composition that will have an anti-inflammatory effect maintaining a normal immune response. Finally, the better understanding of nutrition-cytokine interaction may also be important as this information could be relevant for treatment of patients with cancer or other diseases in which malnutrition is present.     

新疆地区三级甲等医院住院患者营养风险、营养不良(不足)、超重和肥胖发生率及营养支持应用状况

目的调查新疆地区三级甲等医院6个专科住院患者营养风险、营养不良（不足）、超重和肥胖发生率及营养支持应用状况。方法采用定点连续抽样的方法,收集新疆地区5所三级甲等医院中6个专科的住院患者,符合营养风险筛查2002（NRS2002）评分≥3分为有营养风险,体重指数（BMI）〈18．5kg／m2（或白蛋白〈30g／L）为营养不足。在患者人院次日早晨进行NRS2002筛查,并调查2周内（或至出院时）的营养支持状况,分析营养风险和营养支持之间的关系。结果共调查4036例,其中3913例完成NRS2002筛查,营养不良（不足）与营养风险的发生率分别为8．4％和34．2％,实际营养支持率为10．2％,其中肠外营养为8．5％,肠内营养为1．7％,肠外营养：肠内营养为5．1：1。结论通过对新疆地区三级甲等医院的调查发现,NRS方法简单、快捷、方便,能够发现住院患者的营养风险,为进行合理营养支持提供依据,应向临床推广。     

新疆地区三级甲等医院住院患者营养风险、营养不良(不足)、超重和肥胖发生率及营养支持应用状况

Objective To investigate the incidences of nutrition risks, malnutrition ( undernutrition),overweight, and obesity, and nutrition support in tertiary hospitals in Xinjiang Uigur Autonomous Region. Methods Using fixed-point consecutive sampling, we collected the clinical data of inpatients in 6 departments of five tertiary hospitals in Xinjiang. According to the Nutrition Risk Screening 2002 (NRS 2002 ) published by European Society for Parenteral and Enteral Nutrition, patients were graded as at nutritional risk when their NRS 2002 scores ≥3 and as malnutrition when the body mass index (BMI) was ＜ 18.5 kg/m2 (or albumin ＜ 30 g/L). NRS 2002 screening was performed on the next morning after a patient was admitted. The nutrition supports within 2 weeks after admission were also investigated. The relationship between nutrition risks and nutrition support was analyzed.Results A total of 4036 inpatients were investigated, among them 3913 patients received NRS 2002 screening.The malnutrition (undernutrition) rate and the proportion of patients at nutritional risk were 8.4% and 34. 2%, respectively. The percentage of nutrition support was 10. 2%, which included parenteral nutrition (8. 5% ) and ena simple, fast and convenient tool for the investigation of nutrition risks and can provide a basis for reasonable nutrition support Therefore, it should be widely applied in clinical practice.     

Zinc nutrition and HIV infection

The trace element zinc is involved in many important immune processes. A number of immunologic impairments owing to zinc deficiency are also evident in HIV disease, most notably a reduction in the number of circulating T lymphocytes. Observational epidemiologic studies have provided conflicting results on the role of zinc status in HIV disease progression. Randomized, placebo-controlled trials are needed to resolve this controversy. Studies must also address the role of zinc in vertical transmission of HIV from mother to child and its role in reducing the risk of adverse pregnancy outcomes, both of which are of considerable public health importance in developing countries.     

Interaction of nutrition and infection in the hospital setting.

A substantial portion of hospitalized patients suffer from protein-calorie malnutrition acquired as a result of their illness, their semistarvation dietary regimens, or the combination of both insults together. When energy needs are not met by the diet, the deficient calories must come from body stores, muscle, or visceral protein and fat. The status of these stores can be assessed clinically by easily performed measurements. In adult kwashiorkor-like syndromes, the insulin response to the combined stimulus of catabolic stress and carbohydrate feedings reduces the mobilization of fat and protein stores. In adult marasmus there is hypoaminoacidemia and loss of skeletal muscle. Both forms of malnutrition have a profound impact on immune function. Nutritional support should be given preeminent consideration as an additional necessary form of these patients.