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补锌与腹泻病管理

生物学、行为学和背景依据

Waqas Ullah Khan and Daniel W. Sellen, (加拿大多伦多大学)
2011年4月

全世界许多地区持续缺乏安全饮用水和环境卫生设施。因此,在低收入和中等收入国家,腹泻仍然是婴幼儿死亡的最主要原因1. 每年有数百万5岁以下儿童因腹泻而发生体液丢失和脱水,这也是腹泻造成死亡的主要原因。据估计,13%的因疾病、残疾或早逝丧失的寿命年(即“伤残调整寿命年”)归因于腹泻2–5.

因此,针对全球最脆弱儿童制订良好的腹泻临床管理指南极为重要。急性腹泻的临床管理包括两种简单而有效的治疗方法:

  • 使用低浓度的口服补液盐(ORS)
  • 常规补锌10-14天,剂量如下:6月龄以上儿童每日20毫克,6月龄以下儿童每日10毫克6, 7.

口服补液是一种大家熟知且相对简便的治疗方法8–14. 研究发现,补锌可缩短腹泻持续时间,降低其严重程度,预防未来2-3个月内可能出现的继发感染15–18. 儿童及其照护人员通常易于接受补锌15-18,无论采用何种常用类型的锌盐(硫酸锌、乙酸锌或者葡萄糖酸锌),都是有效的7, 19.

补锌对腹泻儿童有益,因为锌是一种重要的微量营养素。对于蛋白质合成、细胞成长和分化、免疫功能以及肠内水和电解质的转运,锌都是必不可少的营养素20–23. 锌对于儿童(无论是否发生腹泻)的正常生长发育也很重要24–26. 缺锌会增加胃肠道感染的风险,对胃肠道的结构和功能产生不良影响,并可削弱免疫功能21, 27–30. 膳食缺锌在低收入国家尤其普遍,因为在这些国家,膳食富锌食物(主要是动物性食物)摄入量偏低或锌吸收不足,因为锌通常与谷物、坚果和豆类内所含的植物纤维和肌醇六磷酸相结合而导致锌吸收不足31, 32.

虽然补锌在腹泻病管理中的益处已得到明确,但在推广实施中仍存在诸多阻碍。目前,在发展中国家,多数腹泻患者并未接受补锌疗法,因为补锌的益处并不被医生和医疗保健工作者广泛认知33. 需要确定补锌的最佳剂量,研究探讨相同的补锌方法是否也使中等收入和高收入国家中的儿童同样受益31. 但同时也存在这样的疑虑:大量摄入锌可能会影响其它微量营养素(如铁和钙)的吸收。这样,反而可能会造成非期望的负面后果,影响儿童的健康和发育31, 34–36. 需要开展研究确定在资源有限的地区哪些亚人群最有可能从补锌中获益,并确保他们获得补锌的机会, 特别是对于那些子女发生腹泻的风险最高,但又无力承担治疗费用(包括补锌)的家庭37. 不过,缺锌较难诊断,因为临床上血清锌含量的测定不一定准确31, 38 .

目前,在需要补锌的儿童中,仅有极少部分能得到补锌治疗37. 补锌与腹泻病管理指南的出台将有助于促进联合国“千年发展目标4”(在2015年前将儿童死亡率降低三分之二)的实现39.


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