RESPONSE OF VISCERAL PROTEINS AND MINERALS TO ACUTE AND CHRONIC STRESS (SERUM, URINARY, ZINC)

摘要

Homeostasis is maintained by a number of physiologic and metabolic mechanisms. When host balance is upset, a series of changes occur (the acute phase response). Increasing evidence suggests that a monokine, Interleukin-1, acts as a common effector for many aspects of the acute phase response-including changes in protein and mineral levels.;Results reported here indicated that in critically ill patients, the levels of albumin and thyroxine-binding prealbumin were good predictors of mortality. In patients with Crohn's disease serum zinc levels were correlated with visceral proteins and anthropometric values. In patients with diabetes mellitus or carcinoma of the lung, serum zinc levels did not correlate with taste test thresholds nor did giving zinc to diabetic patients with low serum zinc levels improve their taste test results. In patients with chronic pancreatitis, impaired absorption of zinc sulfate was corrected with administration of zinc dipicolinate. The excretion of zinc in the urine was increased in various levels of stress--the extent of this zinc loss seemed to correspond with the severity of stress.;The serum levels of zinc, albumin, and thyroxine-binding prealbumin initially decreased and then returned to within normal range by two weeks in the majority of patients with thermal or head injury. As expected, C-Reactive protein levels initially increased as part of the acute phase response. Ceruloplasmin levels decreased and remained below normal in patients with greater than 40% total body surface burn, as did the serum copper levels. In head injury, the serum copper levels increased. The urinary excretions of zinc and copper were elevated, reaching maximum output two weeks post injury. Serum selenium levels were below normal throughout the hospital course despite normal urinary output. Serum and urinary levels of silver were elevated presumably from the cutaneous absorption of the topical antimicrobial silver sulfadiazine.;The similarity in response of serum & urinary zinc, serum albumin, and C-Reactive protein in the different traumas is consistent with a suggestion that Interleukin-1 is the common effector. The different responses of serum copper, ceruloplasmin, and selenium levels may be due to an interaction with silver administered topically in burns.