Hoque Kazi Mirajul, Binder Henry J
Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Gastroenterology. 2006 Jun;130(7):2201-5. doi: 10.1053/j.gastro.2006.02.062.
The improved treatment of acute diarrhea in children during the past 35 years has reduced its morbidity and mortality substantially. However, better therapy still is required. This article reviews the role of oral rehydration solution in the treatment of acute diarrhea with particular attention to recent efforts to develop improved oral rehydration solution formulations. One promising approach is the administration of Zinc (Zn). Based on its beneficial effects in infections, including pneumonia, Zn has been shown to be effective in the treatment of acute diarrhea in several randomized controlled trials including subsequent meta-analyses. Thus, an emerging body of clinical data indicates that Zn can be useful for treating acute diarrhea. However, only limited information is known about the mechanism(s) by which Zn reduces diarrhea. Recent studies have indicated that Zn acts as a K channel blocker of adenosine 3',5'-cyclic monophosphate-mediated chlorine secretion, but may not affect either Ca2+- or guanosine 3',5'-cyclic monophosphate-mediated chlorine secretion. These data provide a strong rationale for further trials testing its efficacy in specific clinical settings and for more detailed physiologic studies examining how Zn exerts its antidiarrheal effect.
在过去35年里，儿童急性腹泻治疗方法的改进已大幅降低了其发病率和死亡率。然而，仍需要更好的治疗方法。本文回顾了口服补液溶液在急性腹泻治疗中的作用，特别关注了近期开发改良口服补液溶液配方的努力。一种有前景的方法是补充锌（Zn）。基于锌在包括肺炎在内的感染中的有益作用，在包括后续荟萃分析在内的多项随机对照试验中，锌已被证明对治疗急性腹泻有效。因此，越来越多的临床数据表明锌可用于治疗急性腹泻。然而，关于锌减少腹泻的机制，人们所知有限。最近的研究表明，锌作为腺苷3',5'-环磷酸介导的氯分泌的钾通道阻滞剂，但可能不影响钙或鸟苷3',5'-环磷酸介导的氯分泌。这些数据为进一步试验测试其在特定临床环境中的疗效以及进行更详细的生理学研究以探究锌如何发挥其止泻作用提供了有力的理论依据。
