Assessments of Nutritional Status and Immunological Responses in Head Trauma: Alterations in Zinc and C-Reactive Protein

頭部外傷病患營養評估及免疫反應－鋅及C-反應蛋白之變化

10.6452/KJMS.199204.0195

林忠男(Chung-Nan Lin)；洪純隆(Shen-Long Howng)；胡淑惠(Su-Huei Hu)；黃宗人(Tsung-Jen Huang)

zinc ； nutrition ； head injury

The Kaohsiung Journal of Medical Sciences

8卷4期（1992 / 04 / 01）

195 - 201

英文

對24例頭部外傷病患進行前瞻性評估，觀察其血液及24小時尿液中鋅含量以及血清C-反應蛋白的變化。病人分為兩群：第一群，14人，葛式昏迷指數（Glasgow Coma Scale , Gcs )介於4到8分之問。第二群，10人，GCS介於9到13分之間。我們嘗試決定不同程度的頭部外傷對這些急性期反應因子的影響。研究期問自入院起至20天為止。 結果顯示：所有病人平均血鋅值在第一至第五天有下降情形，往後才逐漸上升。而低鋅值的發生在第一群病患尤其嚴重。尿鋅值方面，所有病例顯示有大量尿中鋅流失的情形，並持續發生於整個研究期間。相同地，尿中鋅排泄亦以第一群病人較多。事實上，第一群病患其平均最高尿鋅流失高達5000微克／天（正常值小於800微克／天）。兩群病患的血清C-反應蛋白亦明顯上升，第一群病人尤甚（兩群有明顯意義上的差別）。以後其值逐漸下降然末期仍維持在超過正常值範圍。這種急性鋅缺乏及C-反應蛋白上升之相關性意味著低鋅血值可能由外來壓力造成，也同時反應出嚴重頭部外傷病患其營養及代謝功能的改變。

A prospective longitudinal evaluation of zinc and C-reactive protein (CRP) in serum and 24-hour urine was carried out in 24 head-trauma patients. The patients were divided into two groups: group I (14 patients) with Glasgow Coma Scale scores between 4 and 8, and group 11(10 patients) with Glasgow Coma Scale scores between 9 and 13. To understand the influence of severity of injury on the two acute-phase reactants, all patients were studied for a period of up to 20 days after hospital admission. The average serum zinc concentration in all patients decreased from day 1 to day 5, but gradually increased thereafter. The hypozincemia was more severe in group I than in group II. All patients lost zinc throughout the study period and urinary zinc excretion was greater in group I than in group II patients. In group I, the mean peak urinary zinc loss exceeded 5000 jig/day (normal value ＜ 800 jig/day). Serum C-reactive protein levels were markedly elevated on admission especially in group I, then gradually dedined but were still above the normal range on day 20. Acute zinc deficiency with concomitant elevation of CRP supports the hypothesis that acute hypozincemia observed in our patients may be stress-induced and zinc activity may be part of altered nutritional and metabolic responses to severe head injury.