Heyland Daren K, Jones Naomi, Cvijanovich Natalie Z, Wong Hector
Department of Medicine, Queen's University, Kingston, Ontario, Canada.
JPEN J Parenter Enteral Nutr. 2008 Sep-Oct;32(5):509-19. doi: 10.1177/0148607108322402. Epub 2008 Jul 31.
The purpose of the present paper is to provide a rationale for zinc supplementation as a potential therapeutic agent in critically ill patients by describing its role in health and disease, conducting a systematic review of current randomized trials in critical care, considering optimum route and dose of administration, and making recommendations for future research. Normal zinc homeostasis is required for a functional immune system, adequate antioxidant capacity, glucose homeostasis, and wound healing. In addition, zinc is a required cofactor for many enzymes, transcription factors, and replication factors. In non-critically ill patients, zinc supplementation has been associated with an improvement in markers of immune function. In critically ill patients, only 4 randomized trials have examined the effect of zinc supplementation on clinical outcomes. When all 4 studies were aggregated, zinc supplementation was associated with a nonsignificant reduction in mortality (relative risk = 0.63, 95% confidence intervals 0.25-1.59, P = .33) and length of stay in intensive care (-0.35 days, -0.85 to 0.15; P = .17). Thus, because of the paucity of clinical data, there is inadequate evidence to recommend the routine use of high-dose zinc supplementation in the critically ill. A first step would be to determine the optimal dose that has a maximal positive effect on underlying inflammatory, immunologic, and metabolic processes yet is safe and tolerated by critically ill patients. Subsequently, large, rigorously designed, randomized trials are required to elucidate the efficacy of such doses of zinc supplementation in this patient population.
本文旨在通过描述锌在健康与疾病中的作用、对当前危重症护理随机试验进行系统综述、考虑最佳给药途径和剂量以及为未来研究提出建议，为锌补充剂作为危重症患者潜在治疗药物提供理论依据。正常的锌稳态对于功能性免疫系统、足够的抗氧化能力、葡萄糖稳态和伤口愈合是必需的。此外，锌是许多酶、转录因子和复制因子所需的辅助因子。在非危重症患者中，补充锌与免疫功能指标的改善有关。在危重症患者中，仅有4项随机试验研究了补充锌对临床结局的影响。当汇总所有4项研究时，补充锌与死亡率的非显著降低（相对风险=0.63，95%置信区间0.25-1.59，P=0.33）以及重症监护病房住院时间的缩短（-0.35天，-0.85至0.15；P=0.17）相关。因此，由于临床数据匮乏，没有足够证据推荐在危重症患者中常规使用高剂量锌补充剂。第一步是确定对潜在炎症、免疫和代谢过程具有最大积极作用且对危重症患者安全且可耐受的最佳剂量。随后，需要进行大型、设计严谨的随机试验来阐明此类锌补充剂剂量在该患者群体中的疗效。
