維生素B6補充劑的介入對重症病患免疫功能之影響

The Effects of Vitamin B6 Supplementation on Immune Responses In Critically Ill Patients

張素榕(Su-Jung Chang)

指導教授 ： 黃怡嘉

中山醫學大學/健康管理學院/營養學研究所/碩士(2005年)

https://doi.org/10.6834/CSMU.2005.00039

摘要

維生素B6中的磷酸比哆醛 (PLP) 參與體內胺基酸、核酸、肝醣、porphyrin及脂質代謝，因此對於免疫功能有重要影響。研究證實PLP缺乏會影響體液免疫和細胞免疫功能。過去研究指出住院病患有維生素B6缺乏的情形，我們之前的研究也發現重症病患血漿PLP濃度處在臨界缺乏的狀況。因此本研究的目的是：評估重症病患維生素B6的營養狀況與免疫功能的相關性；探討不同劑量的維生素B6補充劑對重症病患免疫功能的影響。研究期間成功募集51位於台中榮總加護病房停留至少14天之重症病患，平均年齡70.2 ± 14.5歲，病患接受維生素B6介入前並未接受B-維生素的補充治療。以隨機方式將病患分為3組：(1) 對照組 (control , n=20)；(2) 50 mg/d維生素B6 (B6-50, n=16)；(3) 100 mg/d維生素B6 (B6-100, n=15)，共介入14天。病患進入加護病房第1天與第14天分別接受體位測量、血液生化值[白蛋白、前白蛋白、白血球 (WBC)、總淋巴球計數 (TLC)、嗜中性白血 (neutrophil)、高敏感度C-反應蛋白 (hs-CRP) ]、維生素B6營養指標 [血漿PLP、比哆醛 (PL)、及比哆酸 (4-PA)、尿液4-PA、紅血球天門冬胺酸轉胺酶活性係數 (EAST –AC)、紅血球丙胺酸轉胺酶活性係數 (EALT-AC) ]的分析。另外以流式細胞儀分析淋巴球亞群 [T淋巴球 (CD3)、B淋巴球 (CD19)、輔助型T淋巴細胞 (CD4) 及抑制型T淋巴細胞 (CD8)]。

結果顯示維生素B6-50及B6-100組在介入14天後，血漿PLP、PL、4-PA及尿液4-PA/creatinine的值顯著高於第一天。維生素B6-50組的CD8百分比及CD3、CD4絕對計數的值皆顯著高第1天；而B6-100組的總淋巴球計數、CD3百分比、CD8百分比及CD4、CD8絕對計數的值也顯著高第1天。相反的，介入14天後，B6-50及B6-100組病人的EAST-AC及EALT-AC值呈顯著下降。對照組在介入14天後，免疫功能指標值並未有任何顯著變化。此外，血漿PLP分別與前白蛋白(r =0.303, p < 0.01)、TLC (r =0.203, p < 0.05)、CD3絕對計數 (r =0.225, p < 0.05)、CD8絕對計數 (r =0.271, p < 0.05) 呈正相關；但與嗜中性白血球 (r =-0.208, p < 0.05) 及hs-CRP (r =-0.305, p < 0.05) 呈負相關。當調整影響免疫功能的一些危險因子，包括年齡、性別、白蛋白、前白蛋白與hs-CRP後，PLP對TLC百分比 (β= 0.078, p = 0.031)、CD3絕對計數(β = 8.752, p = 0.049)、CD8絕對計數 (β= 3.723, p = 0.043)仍有顯著影響。本研究結果顯示重症病患維生素B6的營養狀況與免疫功能有顯著相關性，給予重症病人至少50 mg/d維生素B6補充對重症病人免疫反應有顯著影響，適量的維生素B6補充劑之治療應有助於重症病人提高其免疫功能。

關鍵字

重症病患 ； 維生素B6 ； 補充劑 ； 磷酸比哆醛 ； 免疫功能

並列摘要

Pyridoxal 5’ phosphate (PLP), the physiological active coenzyme form of vitamin B6 is involved in the metabolism of amino acid, nucleic acid, glycogen, porphyrin and lipids. It thus has major effects on immune functions. Vitamin B6 has been found to involve in the humoral- and cell-mediated immunity, several studies have reported lower vitamin B6 status in hospitalized patients. Our previous study also showed that critically ill patients had marginal vitamin B6 deficiency.The purpose of this study were: (1) to assess vitamin B6 status and immune functions in the critically ill patients; (2) to investigate the effects of various doses of vitamin B6 supplementation on immune responses in critically ill patients. Fifty-one patients who stayed over 14 days in the intensive care unit of Taichung Veteran General Hospital successfully completed the study. The mean age of subjects was 70.2 ± 14.5 years old. Subjects were not treated with any vitamin supplement before the intervention. Patients were randomly assigned to 3 groups and treated with a daily dose of 0 mg vitamin B6 (control, n=20), 50 mg/d B6 (B6-50, n=16) or 100 mg/d B6 ( B6-100, n=15 ) for 14 days. At 1st and 14th d of admission, biochemical measurements, hematological measurements [white blood cell (WBC), total lymphocyte count (TLC), neutrophils, albumin, transferring, prealbumin, hemoglobin, hematocrit, high sensitive- C reactive protein (hs-CRP)] were determined. Lymphocyte subsets [T lymphocyte (CD3, B lymphocyte (CD19), T helper lymphocyte(CD4), T suppress or lymphocyte (CD8)] were analyzed by flow cytometry. Vitamin B6 status was assessed by plasma PLP, pyridoxal (PL), 4-pyridoxic acid (4-PA), urine 4-PA, and erythrocyte aspartate transaminaes activity cofficients (EAST–AC), erythrocyte alanine transaminaes activity cofficients (EALT–AC).
After 14 days of vitamin B6 supplementation, plasma PLP, PL, 4-PA, urine 4-PA and 4-PA/creatinine levels significantly increased in B6-50 and B6-100 groups. CD3, CD4 absolute count and CD8 percentage significantly increased in the B6-50 group. TLC, CD4 and CD8 absolute count, CD3 and CD8 percentage significantly increased in the B6-100 group. However, the values of EAST-AC, EALT-AC significantly decreased in B6-50 and B6-100 groups after day 14. There were no significant differences with respect to immune responses in the control group. Plasma PLP concentration was positively correlated with albumin (r = 0.303, p < 0.01), TLC (r = 0.203, p < 0.05), CD3 (r = 0.225, p < 0.05) and CD8 (r = 0.271, p < 0.05) absolute count; however, plasma PLP concentration was negatively correlated with neutrophils (r = -0.208, p < 0.05) and hs-CRP (r = -0.305, p < 0.05). After adjusting for age, sex, albumin and/or prealbumin and hs-CRP, plasma PLP still significantly affected TLC, CD3 and CD8. The data herein indicate that plasma PLP is significantly correlated with immune function in critically ill patients, at least 50 mg/d vitamin B6 supplementation might improve the immune function of critically ill patients.

並列關鍵字

critically ill patients ； vitamin B6 ； supplemention ； pyridoxal 5’-phosphate ； immune function

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