Corporación Ecuatoriana de Biotecnología, Quito, Ecuador (FS, BE, and OR); the Universidad Central del Ecuador, Escuela de Medicina, Quito, Ecuador (FS and BE); the Hospital de Niños Baca Ortiz, Quito, Ecuador (DG, MC, and GS); the Center for Global Health and Development, Boston University, Boston, MA (LLS and DHH); the Department of International Health, School of Public Health, Boston University, Boston, MA (LLS and DHH); the Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA (DHH); and the Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA (DHH).
Am J Clin Nutr. 2014 Mar;99(3):497-505. doi: 10.3945/ajcn.113.067892. Epub 2014 Jan 15.
Studies of zinc as an adjunct to treatment of severe pneumonia in children have shown mixed results, possibly because of poor information on zinc status and respiratory pathogens.
We evaluated the effect of zinc given with standard antimicrobial treatment on the duration of respiratory signs in children with severe pneumonia. Zinc status and pathogens were assessed.
Children aged 2-59 mo with severe pneumonia who were admitted to the main children's hospital in Quito, Ecuador, were given standard antibiotics and randomly allocated to receive zinc supplements twice daily or a placebo. Measurements included anthropometric variables, breastfeeding, hemoglobin, plasma zinc, and common bacteria/viral respiratory pathogens. The primary outcome was time to resolution of respiratory signs. The secondary outcome was treatment failure.
We enrolled 225 children in each group. There was no difference between groups in time to resolution of respiratory signs or treatment failure; pathogens were not associated with outcomes. Tachypnea and hypoxemia resolved faster in older children (P = 0.0001) than in younger ones. Higher basal zinc concentration (P = 0.011) and better height-for-age z score (HAZ) (P = 0.044) were associated with faster resolution of chest indrawing. Better weight-for-height z score (WHZ) (P = 0.031) and HAZ (P = 0.048) were associated with faster resolution of tachypnea. Increased C-reactive protein was associated with a longer duration of tachypnea (P = 0.044).
Zinc did not affect time to pneumonia resolution or treatment failure, nor did type of respiratory pathogens affect outcomes. Higher basal zinc and better HAZ and WHZ were associated with reduced time to resolution of respiratory signs. These results suggest the need for prevention of chronic zinc deficiency and improvement of general nutritional status among Ecuadorian children.
研究表明，锌作为儿童重症肺炎治疗的辅助药物，其效果不一，这可能是因为锌的状态和呼吸道病原体的信息不足。
我们评估了在标准抗菌治疗的基础上给予锌对重症肺炎患儿呼吸症状持续时间的影响。评估了锌的状态和病原体。
厄瓜多尔基多主要儿童医院收治的 2-59 月龄患有重症肺炎的儿童接受标准抗生素治疗，并随机分为每日接受锌补充剂两次或安慰剂组。测量包括人体测量学变量、母乳喂养、血红蛋白、血浆锌和常见的细菌/病毒呼吸道病原体。主要结局是呼吸症状缓解的时间。次要结局是治疗失败。
每组 225 名儿童入组。两组在呼吸症状缓解时间或治疗失败方面无差异；病原体与结局无关。与年龄较小的儿童相比，年龄较大的儿童（P = 0.0001）呼吸急促和低氧血症更快缓解。较高的基础锌浓度（P = 0.011）和更好的身高别年龄 Z 评分（HAZ）（P = 0.044）与胸部凹陷的更快缓解相关。更好的体重身高 Z 评分（WHZ）（P = 0.031）和 HAZ（P = 0.048）与呼吸急促的更快缓解相关。C 反应蛋白增加与呼吸急促持续时间较长有关（P = 0.044）。
锌并未影响肺炎缓解时间或治疗失败，呼吸道病原体类型也未影响结局。较高的基础锌和更好的 HAZ 和 WHZ 与呼吸症状缓解时间的缩短有关。这些结果表明，厄瓜多尔儿童需要预防慢性锌缺乏症，并改善其一般营养状况。
