Strand Tor Arne, Chandyo Ram Krisna, Bahl Rajiv, Sharma Pushpa Raj, Adhikari Ramesh Kant, Bhandari Nita, Ulvik Rune Johan, Mølbak Kåre, Bhan Maharaj Krishan, Sommerfelt Halvor
Center for International Heath, University of Bergen, Bergen, Norway.
Pediatrics. 2002 May;109(5):898-903. doi: 10.1542/peds.109.5.898.
Intervention trials have shown that zinc is efficacious in treating acute diarrhea in children of developing countries. In a randomized, placebo-controlled trial, we assessed the effectiveness and efficacy of giving 3 Recommended Daily Allowances of elemental zinc to 6- to 35-month-old children with acute diarrhea.
Seventeen hundred ninety-two cases of acute diarrhea in Nepalese children were randomized to 4 study groups. Three groups were blinded and the children supplemented daily by field workers with placebo syrup, zinc syrup, or zinc syrup and a massive dose of vitamin A at enrollment. The fourth group was open and the caretaker gave the children zinc syrup daily. Day-wise information on morbidity was obtained by household visits every fifth day.
The relative hazards for termination of diarrhea were 26% (95% confidence interval [CI]: 8%, 46%), 21% (95% CI: 4%, 38%), and 19% (95% CI: 2%, 40%) higher in the zinc, zinc-vitamin A, and zinc-caretaker groups, respectively, than in the placebo group. The relative risks of prolonged diarrhea (duration >7 days) in these groups were 0.57 (95% CI: 0.38, 0.86), 0.53 (95% CI: 0.35, 0.81), and 0.55 (0.37, 0.84); zinc accordingly reduced the risk of prolonged diarrhea with 43% to 47%. Five percent and 5.1% of all syrup administrations were followed by regurgitation in the zinc and zinc-vitamin A group, respectively, whereas this occurred after only 1.3% of placebo administrations. Vomiting during diarrhea was also more common in children receiving zinc.
Three Recommended Daily Allowances of zinc given daily by caretakers or by field workers substantially reduced the duration of diarrhea. The effect of zinc was not dependent on or enhanced by concomitant vitamin A administration.
干预试验表明，锌对治疗发展中国家儿童的急性腹泻有效。在一项随机、安慰剂对照试验中，我们评估了给6至35个月大的急性腹泻儿童补充3倍推荐每日摄入量的元素锌的有效性和疗效。
1792例尼泊尔儿童急性腹泻病例被随机分为4个研究组。3个组为盲法，现场工作人员在入组时每天给儿童补充安慰剂糖浆、锌糖浆或锌糖浆加大量维生素A。第4组为开放组，由照料者每天给儿童补充锌糖浆。每隔5天通过家访获取每日发病情况信息。
锌组、锌 - 维生素A组和锌 - 照料者组腹泻停止的相对风险分别比安慰剂组高26%（95%置信区间[CI]：8%，46%）、21%（95%CI：4%，38%）和19%（95%CI：2%，40%）。这些组中腹泻持续时间延长（>7天）的相对风险分别为0.57（95%CI：0.38，0.86）、0.53（95%CI：0.35，0.81）和0.55（0.37，0.84）；因此锌将腹泻持续时间延长的风险降低了43%至47%。锌组和锌 - 维生素A组分别有5%和5.1%的糖浆服用后出现反流，而安慰剂服用后仅1.3%出现反流。腹泻期间呕吐在接受锌治疗的儿童中也更常见。
照料者或现场工作人员每天给予3倍推荐每日摄入量的锌可显著缩短腹泻持续时间。锌的效果不依赖于同时给予维生素A，也不会因同时给予维生素A而增强。
