微量营养素补充对胸内结核患儿治疗结局的影响：一项随机对照试验。
Effect of micronutrient supplementation on treatment outcomes in children with intrathoracic tuberculosis: a randomized controlled trial.
作者信息
Lodha Rakesh, Mukherjee Aparna, Singh Varinder, Singh Sarman, Friis Henrik, Faurholt-Jepsen Daniel, Bhatnagar Shinjini, Saini Savita, Kabra Sushil K, Grewal Harleen M S
机构信息
From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
出版信息
Am J Clin Nutr. 2014 Nov;100(5):1287-97. doi: 10.3945/ajcn.113.082255. Epub 2014 Sep 10.
BACKGROUND
Micronutrients play an important role in immune function. To our knowledge, there have been no comprehensive studies on the role of micronutrient supplementation in children with tuberculosis.
OBJECTIVE
We assessed the effect of micronutrient supplementation in children treated with antituberculosis therapy (ATT).
DESIGN
A randomized, double-blind, placebo-controlled trial that used a 2 × 2 factorial design was undertaken at 2 teaching hospitals in Delhi. Children with newly diagnosed intrathoracic tuberculosis were enrolled, and they received ATT together with daily supplementation for 6 mo with either zinc alone, micronutrients without zinc, micronutrients in combination with zinc, or a placebo. Main outcomes were weight gain and an improvement in a chest X-ray (CXR) lesion assessed at 6 mo of treatment.
RESULTS
A total of 403 children were enrolled and randomly assigned. A microbiological diagnosis of tuberculosis was confirmed in 179 children (44.4%). The median (95% CI) increase in weight-for-age z score at 6 mo was not significantly different between subjects who received micronutrients [0.75 (0.66, 0.84)] and those who did not receive micronutrients [0.76 (0.67, 0.85)] and between subjects who received zinc [0.76 (0.68, 0.85)] and those who did not receive zinc [0.75 (0.66, 0.83)]. An improvement in CXR was observed in 285 children, but there was no difference between those receiving zinc and no zinc or between those receiving micronutrients and no micronutrients after 6 mo of ATT. However, children who received micronutrients had a faster gain in height over 6 mo than did those who did not receive micronutrients (height-for-age z score Δ = 0.08; P = 0.014).
CONCLUSIONS
Micronutrient supplementation did not modify the weight gain or clearance of lesions on CXR in children with intrathoracic tuberculosis. However, micronutrient supplementation during treatment may improve height gain in children with intrathoracic tuberculosis. This trial was registered at clinicaltrials.gov as NCT00801606.
背景
微量营养素在免疫功能中发挥着重要作用。据我们所知，尚未有关于补充微量营养素对儿童结核病作用的全面研究。
目的
我们评估了补充微量营养素对接受抗结核治疗（ATT）的儿童的影响。
设计
在德里的两家教学医院进行了一项采用2×2析因设计的随机、双盲、安慰剂对照试验。纳入新诊断的胸内结核病儿童，他们接受ATT并每日补充以下其中一种物质，为期6个月：单独补充锌、不包含锌的微量营养素、锌与微量营养素联合补充或安慰剂。主要结局指标为治疗6个月时的体重增加情况以及胸部X光（CXR）病变的改善情况。
结果
共纳入403名儿童并随机分组。179名儿童（44.4%）确诊为结核病。接受微量营养素补充的受试者[0.75（0.66，0.84）]与未接受微量营养素补充的受试者[0.76（0.67，0.85）]之间，以及接受锌补充的受试者[0.76（0.68，0.85）]与未接受锌补充的受试者[0.75（0.66，0.83）]之间，6个月时年龄别体重Z评分的中位数（95%CI）增加无显著差异。285名儿童的CXR有所改善，但在ATT治疗6个月后，接受锌补充和未接受锌补充的儿童之间以及接受微量营养素补充和未接受微量营养素补充的儿童之间并无差异。然而，接受微量营养素补充的儿童在6个月内的身高增长比未接受微量营养素补充的儿童更快（年龄别身高Z评分差值 = 0.08；P = 0.014）。
结论
补充微量营养素并未改变胸内结核病儿童的体重增加或CXR病变的清除情况。然而，治疗期间补充微量营养素可能会改善胸内结核病儿童的身高增长。本试验已在clinicaltrials.gov注册，注册号为NCT00801606。
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