
锌制剂辅助治疗婴幼儿轮状病毒性肠炎的疗效观察
Therapeutic effects of zinc supplement as adjunctive therapy in infants and young children with rotavirus enteritis
目的 探讨口服锌制剂对婴幼儿轮状病毒性肠炎的治疗效果及对后续3个月内再发腹泻的预防作用。方法 103例轮状病毒性肠炎患儿随机分为补锌治疗组 (51例)及常规治疗组 (52例)。两组均采用相同的综合治疗方案,在此基础上,补锌治疗组加服葡萄糖酸锌颗粒10 d。观察两组治疗72 h后的疗效、阳性症状消失所需的时间和肠道外脏器损害的恢复情况;同时随访观察两组患儿在后续3个月内再次腹泻的发生率。结果 补锌治疗组总有效率显著高于常规治疗组 (90% vs 75%,P < 0.05)。补锌治疗组治疗后高热、呕吐以及腹泻的持续时间均短于常规治疗组 (P < 0.05)。后续3个月内补锌治疗组再次腹泻以及严重腹泻的发生率均明显低于常规治疗组 (P < 0.05)。结论 口服锌制剂辅助治疗婴幼儿轮状病毒性肠炎有显著疗效,同时可降低患儿后续3个月再次发生腹泻的可能性以及减轻再发腹泻的严重程度。
Objective To investigate the therapeutic effects of oral zinc supplement in infants and young children with rotavirus enteritis, and its preventive effects against diarrhea recurrence within 3 months after treatment. Methods A total of 103 infants and young children with rotavirus enteritis were randomly divided into zinc supplement group (n=51) and conventional treatment group (n=52). Both groups were equally treated with a comprehensive therapy, besides which the zinc supplement group received zinc gluconate granules for 10 days. The treatment outcomes were examined at 72 hours after treatment, and the time required for the disappearance of positive symptoms and the recovery of injured extra-intestinal organs were determined. In addition, these patients were followed up for 3 months to determine the incidence of diarrhea recurrence after treatment. Results The overall response rate in the zinc supplement group was significantly higher than that in the conventional treatment group (90% vs 75%; P < 0.05). The durations of diarrhea, high fever, and vomiting in the zinc supplement group were significantly shorter than that in the conventional treatment group (P < 0.05). In addition, the recurrence rate of diarrhea and the incidence of severe diarrhea within 3 months after treatment in the zinc supplement group were significantly lower than in the conventional treatment group (P < 0.05). Conclusions Oral zinc supplement as adjunctive therapy is effective in treating infants and young children with rotavirus enteritis, and reducing the incidence and severity of diarrhea recurrence in the subsequent 3 months.
锌制剂 / 轮状病毒 / 肠炎 / 治疗 / 预防 / 婴幼儿
Zinc supplement / Rotavirus / Enteritis / Treatment / Prevention / Infant and young child
[1] Parashar UD, Gibson CJ, Bresee JS, et al. Rotavirus and severe childhood diarrhea[J]. Emerg Infect Dis, 2006, 12(2):304-306.
[2] World Health Organization; UNICEF. Clinical management of acute diarrhoea-WHO/UNICEF Joint Statement[EB/OL]. (May, 2004). http://www.who.int/maternal_child_adolescent/documents/who_fch_cah_04_7/en/.
[3] 鲁继荣. 呼吸系统疾病[M]//沈晓明, 王卫平. 儿科学. 第7版. 北京:人民卫生出版社, 2008:259-281.
[4] 方鹤松, 魏承毓, 段恕诚, 等. 98全国腹泻病防治学术研讨会会议纪要[J]. 中华儿科杂志, 1999, 37(4):239.
[5] Kotloff KL, Nataro JP, Blackwelder WC, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS):a prospective, case-control study[J]. Lancet, 2013, 382(9888):209-222.
[6] 张丽杰, 方安. 中国婴幼儿轮状病毒腹泻的流行病学和疾病负担研究进展[J].中国计划免疫杂志, 2007, 13(2):186-191.
[7] 张勇, 马战英. 小儿轮状病毒肠炎与肠道外损害的临床分析[J].广东医学, 2011, 32(6):766-768.
[8] 何扬帆, 杨炳中, 谭汉梅, 等. 婴幼儿轮状病毒性肠炎肠外表现145例临床分析[J]. 重庆医学, 2010, 39(8):962-964.
[9] 江超雄, 王慧, 许春娣, 等. 消旋卡多曲颗粒联合葡萄糖酸锌治疗轮状病毒所致水样腹泻的疗效观察[J]. 儿科药学, 2014, 20(9):15-17.
[10] 康春华, 丘小汕, 华莉, 等. 轮状病毒肠炎患儿血锌水平变化及补锌治疗效果[J]. 实用儿科临床杂志, 2008, 23(10):765-766.
[11] 张晓芬, 刘晓红. 葡萄糖酸锌片辅助治疗轮状病毒性肠炎的疗效[J]. 实用医学杂志, 2012, 28(14):2433-2435.
[12] Fischer Walk CL, Ezzati M, Black RE. Global and regional child mortality and burden of disease attributable to zinc deficiency[J]. Eur J Clin Nutr, 2009, 63(5):591-597.
[13] 钱发英. 葡萄糖酸锌口服液联合消旋卡多曲治疗小儿轮转病毒肠炎的疗效观察[J]. 海峡药学, 2013, 25(2):172-173.
[14] Alam DS, Yunus M, El Arifeen S, et al. Zinc treatment for 5 or 10 days is equally efficacious in preventing diarrhea in the subsequent 3 months among Bangladeshi children[J]. J Nutr, 2011, 141(2):312-315.
[15] Hambidge M. Human zinc deficiency[J]. J Nutr, 2000, 130(5S Suppl):1344S-1349S.
[16] Overbeck S, Rink L, Haase H. Modulating the immune response by oral zinc supplementation:a single approach for multiple diseases[J]. Arch Immunol Ther Exp (Warsz), 2008, 56(1):15-30.
[17] 顾蓁, 沈华琴, 赵普. 锌制剂防治小儿急性腹泻效果观察[J]. 临床儿科杂志, 2011, 29(3):249-251.
上海市黄浦区科委资助科研项目(HKW201439)。