锌作为低收入和中等收入国家2至60个月儿童肺炎辅助治疗的疗效：一项系统评价和荟萃分析。
Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis.
作者信息
Brown Nick, Kukka Antti Juhani, Mårtensson Andreas
机构信息
IMCH, Kvinno och barnhälsa, Uppsala Universitet, Uppsala, Sweden.
Paediatrics, Region Gävleborg, Gavle, Gävleborg, Sweden.
出版信息
BMJ Paediatr Open. 2020 Jul 12;4(1):e000662. doi: 10.1136/bmjpo-2020-000662. eCollection 2020.
BACKGROUND
Despite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active.
METHODS
Systematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed.
RESULTS
We identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions.
CONCLUSION
There is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs.
TRIAL REGISTRATION NUMBER
CRD42019141602.
背景
尽管在疫苗接种和病例管理方面取得了进展，但肺炎仍然是全球幼儿早期死亡的最大单一原因。锌具有免疫增强特性，但其在低收入和中等收入国家（LMICs）肺炎辅助治疗中的作用存在争议，相关研究仍在进行中。
方法
对LMICs中2至60个月儿童肺炎患者使用锌剂和安慰剂的随机对照试验进行系统评价和荟萃分析。数据库包括MEDLINE、Cochrane图书馆、EMBASE、LILACS、SciELO、世界卫生组织门户网站、Scopus、谷歌学术和ClinicalTrials.gov。纳入标准包括肺炎的公认体征和明确的结局测量指标。两位作者独立评估偏倚风险。采用95%置信区间的比值比（OR）计算包括治疗失败和死亡率在内的二分结局的合并估计值。恢复时间用风险比（HR）表示。进行了考虑偏倚风险的敏感性分析和肺炎严重程度的亚组分析。
结果
我们确定了2004年至2019年间发表的11项试验，这些试验符合预先定义的标准，其中7项来自南亚，3项来自非洲，1项来自南美洲。对所有患者进行分析时，锌剂组和安慰剂组的比例治疗失败率相当（OR 0.95（95% CI 0.80至1.14）），仅对重症肺炎患者而言也是如此（OR 0.93（95% CI 0.75至1.14））。锌剂组和安慰剂组的死亡率无差异（OR 0.64（95% CI 0.31至1.31））。重症肺炎患者的治疗组和对照组从重症肺炎中恢复的时间没有差异（HR 1.01（95% CI 0.89至1.14））。剔除四项高偏倚风险研究对结论没有影响。
结论
没有证据表明辅助锌剂治疗能改善LMICs儿童肺炎的恢复情况。
试验注册号
CRD42019141602。
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