Van Wouwe J P
Department of Pediatrics, Drechtsteden Hospital Jacobus, Zwijndrecht, The Netherlands.
Biol Trace Elem Res. 1995 Aug-Sep;49(2-3):211-25. doi: 10.1007/BF02788969.
The clinical spectrum of acrodermatitis enteropathica (n = 226) is compared with symptoms reported in other Zn deficiencies: total parenteral nutrition without Zn (n = 21), protein energy malnutrition (n = 24), gastrointestinal disease (n = 79), geophagia (n = 227), and dietary low intake (n = 23). Common features of deficiency are diarrhea, recurrent infection, and growth retardation. Dermatitis is less common in other types of deficiency than in acrodermatitis enteropathica (9 vs 88% of cases). Anorexia and/or hypogeusia is reported more frequently in the other types of deficiency (30 vs 16%). The main symptoms in acrodermatitis enteropathica vary with age. These differences in the clinical picture of Zn deficiency are discussed in relation to the degree of the deficiency (acute, subacute, or chronic; severe, mild, or subclinical). The results of the conventional laboratory tests to diagnose Zn deficiency (Zn levels in serum, urine, or hair) are reviewed. In healthy Dutch infants and children, the mean values of these levels vary by a factor of 1.6-3.0. Also, the clinical interpretation of their results is prone to errors. Therefore, we advocate the erythrocytic 65Zn uptake test. Its mean varies by 1.3. However, its reference values for different age intervals need to be established. From the comparison of the results of three conventional tests of samples taken concurrently (serum, urine, and hair) in groups of Dutch children with symptoms common in Zn deficiency (diarrhea, recurrent infection, or growth retardation), it is estimated that +/- 1% of Dutch children with minor complaints suffer from either acute or subacute Zn deficiency. Other deficiencies occur occasionally. In order to detect the individual patient with deficiency, the erythrocytic 65Zn uptake test is promising and needs to be evaluated. Therefore, we review a set of reference laboratory tests with results that alter during sequential stages of overload and deficiency. Such a scheme is advocated as a guidance for future clinical research on deficiency, and solves the problem of differentiating those conditions that identify the individual patients who need treatment by supplementation.
将肠病性肢端皮炎（n = 226）的临床谱与其他锌缺乏症所报告的症状进行比较：无锌的全胃肠外营养（n = 21）、蛋白质能量营养不良（n = 24）、胃肠疾病（n = 79）、食土癖（n = 227）以及饮食锌摄入量低（n = 23）。锌缺乏的共同特征是腹泻、反复感染和生长发育迟缓。皮炎在其他类型的锌缺乏症中比在肠病性肢端皮炎中少见（9%对88%的病例）。厌食和/或味觉减退在其他类型的锌缺乏症中报告更为频繁（30%对16%）。肠病性肢端皮炎的主要症状随年龄而异。锌缺乏临床表现的这些差异与缺乏的程度（急性、亚急性或慢性；严重、轻度或亚临床）相关进行了讨论。回顾了用于诊断锌缺乏的传统实验室检查结果（血清、尿液或头发中的锌水平）。在健康的荷兰婴儿和儿童中，这些水平的平均值相差1.6至3.0倍。此外，其结果的临床解读容易出错。因此，我们提倡红细胞65锌摄取试验。其平均值相差1.3倍。然而，需要确定其在不同年龄区间的参考值。通过对有锌缺乏常见症状（腹泻、反复感染或生长发育迟缓）的荷兰儿童组同时采集的样本（血清、尿液和头发）进行三项传统检查结果的比较，估计有轻微不适的荷兰儿童中有±1%患有急性或亚急性锌缺乏。其他缺乏症偶尔发生。为了检测个体锌缺乏患者，红细胞65锌摄取试验很有前景且需要评估。因此，我们回顾了一组参考实验室检查，其结果在锌过载和缺乏的连续阶段会发生变化。这样一个方案被提倡作为未来锌缺乏临床研究的指导，并解决了区分那些确定需要通过补充进行治疗的个体患者的病症的问题。
