| Summary: | 碩士 === 中山醫學大學 === 營養學研究所 === 98 === Critically ill patients are likely to have stress hyperglycemia, systemic inflammation, hyperhomocysteinemia, and compromised vitamin B-6 status. The biologically active form of vitamin B-6 is pyridoxal 5’-phosphate (PLP), which functions as a coenzyme in gluconeogenesis and glycogenolysis. Vitamin B-6 is also involved in the synthesis of nucleic acids, mRNA, and protein synthesis, thus the production of cytokines and inflammatory mediators during inflammatory responses might increase the use of PLP. In addition, PLP also acts as the coenzyme in the metabolism of homocysteine. Critically ill patients with compromised vitamin B-6 status may have higher blood glucose and inflammatory responses, and hyperhomocysteinemia. The purposes of this study were to compare the differences of blood glucose, inflammatory responses and plasma homocysteine concentration between adequate vitamin B-6 (PLP ≧ 20 nmol/L) and deficient (PLP < 20 nmol/L) groups, and additionally to examine the relationship of vitamin B-6 status with blood glucose, inflammatory responses and plasma homocysteine concentration in critically ill surgical patients. This was a cross-sectional study. Thirty-four patients were recruited from the surgical intensive care unit (SICU) of Changhua Christian Hospital. Anthropometric and clinical measurements (i.e., blood glucose, serum albumin, insulin, glycated hemoglobin, C-reactive protein), severity of illness (APACHE II score), vitamin B-6 status [i.e., plasma PLP, pyridoxal (PL) and 4-pyridoxic acid (4-PA), erythrocyte PLP, erythrocyte alanine aminotransferase activity coefficient (EALT-AC) and erythrocyte aspartate aminotransferase activity coefficient (EAST-AC)], inflammatory response indicators [ie., interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α)] and plasma homocysteine concentration were assessed and measured at the 1st and 8th day of admission to the SICU. Patients were allocated to either adequate (n = 20) or deficient (n = 14) vitamin B-6 groups according to their baseline plasma PLP level. Results showed that patients in the adequate and deficient groups were both having hyperglycemia (175.07 ± 16.02 vs. 161.25 ± 6.20 mg/dL, respectively) at the 1st day of admission. Patients with vitamin B-6 deficiency had no significant changes in blood glucose concentration (171.86 ± 29.69 mg/dL) at day 8; whereas there was a significant 37.5 mg/dL of blood glucose reduction in patients with adequate vitamin B-6 status at day 8. The change of erythrocyte PLP concentration was negatively correlated with the change of blood glucose concentration (β = -0.726, p = 0.029) in all subjects. Plasma IL-6 concentrations were significantly decreased at day 8 in patients with adequate vitamin B-6. Plasma PLP, PL and 4-PA, erythrocyte PLP, EALT-AC and EAST-AC did not significantly correlat with C-reactive protein, IL-6 and TNF-α in all subjects. Plasma homocysteine concentration was significantly reduced at day 8 in both groups. Erythrocyte PLP was negatively correlated with plasma homocysteine concentration (r = -0.268, p = 0.027), while plasma 4-PA (r = 0.252, p = 0.038) and erythrocyte EALT-AC (r = 0.287, p = 0.018) were significantly positively correlated with homocysteine concentration in all subjects. Critically ill patients with adequate vitamin B-6 status at admission have better blood glucose response and lower homocysteine and IL-6 concentrations at day 8. However, further studies are warranted to investigate the relationship between plasma PLP, erythrocyte PLP and blood glucose, inflammatory response and plasma homocysteine concentration.
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