School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa.
Am J Clin Nutr. 2011 Jan;93(1):93-100. doi: 10.3945/ajcn.110.001784. Epub 2010 Nov 10.
Low serum concentrations of vitamin A and zinc are common in tuberculosis and may have an adverse effect on host cell-mediated responses. The role of adjunctive micronutrient supplementation on treatment outcomes is uncertain.
The objective was to assess the efficacy of vitamin A and zinc supplementation on sputum smear and culture conversion and time to culture detection in adults with sputum smear-positive pulmonary tuberculosis.
Participants attending a primary care tuberculosis clinic in Cape Town, South Africa, were randomly assigned to receive micronutrients (single dose of 200,000 IU retinyl palmitate plus 15 mg Zn/d for 8 wk) or matching placebo. Sputum was collected weekly for 8 wk for auramine staining and culture on liquid media (BACTEC MGIT 960; Becton Dickinson, Sparks, MD). Performance status, chest radiographs, and anthropometric measures were assessed at baseline and again at 8 wk.
The participants (n = 154) were randomly assigned to the micronutrient (n = 77) or placebo (n = 77) group. Twenty participants were HIV infected (13%), and 12 participants had an unknown HIV status (8%). No differences in time to smear or culture conversion were observed between the treatment groups by Kaplan-Meier analysis (P = 0.15 and P = 0.38, respectively; log-rank test). Log-logistic regression analysis found no significant group interaction effect in time to culture detection over the 8-wk period (P = 0.32). No significant differences in weight gain (2.3 ± 3.5 compared with 2.2 ± 2.4 kg, P = 0.68) or radiologic resolution were observed between the treatment groups.
Supplementation with vitamin A and zinc did not affect treatment outcomes in participants with pulmonary tuberculosis at 8 wk. This trial was registered at controlled-trials.com as ISRCTN80852505.
维生素 A 和锌的血清浓度低在肺结核中很常见，可能对宿主细胞介导的反应产生不利影响。辅助补充微量营养素对治疗结果的作用尚不确定。
评估维生素 A 和锌补充剂对痰涂片阳性肺结核成人痰涂片和培养转化以及培养检测时间的疗效。
参与者来自南非开普敦的初级保健结核诊所，随机分配接受微量营养素（单剂量 20 万国际单位棕榈酸视黄酯加 15 毫克锌/天，持续 8 周）或匹配的安慰剂。在第 8 周，每周采集痰标本进行金胺染色和液体培养基培养（BACTEC MGIT 960；Becton Dickinson，马里兰州 Sparks）。在基线和第 8 周评估表现状态、胸部 X 线片和人体测量指标。
参与者（n = 154）被随机分配到微量营养素（n = 77）或安慰剂（n = 77）组。20 名参与者感染了 HIV（13%），12 名参与者的 HIV 状态未知（8%）。通过 Kaplan-Meier 分析，在治疗组之间未观察到时间到涂片或培养转化的差异（P = 0.15 和 P = 0.38，分别为对数秩检验）。对数逻辑回归分析发现，在 8 周期间，在培养检测时间方面，组间无显著交互作用效应（P = 0.32）。在治疗组之间，体重增加（2.3 ± 3.5 与 2.2 ± 2.4 kg，P = 0.68）或放射学分辨率无显著差异。
在 8 周时，补充维生素 A 和锌对肺结核患者的治疗结果没有影响。这项试验在 controlled-trials.com 上注册为 ISRCTN80852505。
