脓毒症病人血清微量元素改变与预后的关系

Determination of serum levels of copper,iron,zinc and selenium in septic patients and their clinical significance

目的：研究微量元素铜、铁、锌、硒在脓毒症疾病过程中的变化，探讨这些变化与疾病的严重度和预后的关系。方法：选择３０例脓毒症病人作为治疗组，另选３０例健康人作为对照组。在脓毒症病人发病的第１、４、７、１４天测定血清铜、铁、锌、硒水平，同时评估脓毒症病人的ＡＰＡＣＨＥⅡ评分。血清铜、铁、锌的检测采用原子吸收光谱火焰法，血清硒的检测采用原子吸收光谱氢化物发生法。结果：①脓毒症病人血清铜水平明显升高，存活组明显高于非存活组。②脓毒症病人血清铁、锌水平显著低于对照组，但存活与非存活组之间没有显著性差异。③脓毒症病人血清硒水平在感染的第１、４、７天均明显低于对照组，非存活组血清硒水平明显低于存活组。④脓毒症病人的ＡＰＡＣＨＥⅡ评分与血清硒水平呈显著负相关。结论：脓毒症病人血清铜水平明显升高，而血清铁、锌及硒水平明显降低，其中血清硒水平的变化与疾病的严重度及预后有密切的关系。

Objectives:To observe the changes of copper,iron,zinc and selenium in serum of septic patients and study the relationship between these changes and the prognosis. Methods:30 patients with sepsis were selected to determine the serum levels of copper,iron,zinc and selenium on the 1th,4th,7th,14th day after diagnosis of sepsis.30 healthy persons were determind as control. Results:The level of serum copper was obviously higher in the septic group than in the control group,and serum copper level in the survival sub group was significantly higher than in the non survival sub group.The levels of serum iron,zinc in septic group were significantly decreased when compared with the control group.Serum selenium level in the septic group was significantly decreased comparing to the control group,and was obviously higher in the survival sub group than in the non survival sub group.There was a significant correlation between serum selenium level and APCHEⅡ score. Conclusions:Serum level of copper is increased in sepsis.The levels of serum iron,zinc and selenium will decrease significantly and there is a close relationship between serum selenium level and the severity and prognosis of septic patients.Low level of serum copper in the early stage of sepsis means that the progosis will become worse.