不同剂量锌治疗儿童腹泻有效性和安全性的系统评价  

Efficacy and safety of different doses of zinc in the treatment of diarrhea in children:a systematic review

作　　者：涂彩霞 任丹阳[1] 李云巍[1] 杨琰茗 沈建玲 刘艳 刘婷 李惠英[1] TU Caixia;REN Danyang;LI Yunwei;YANG Yanming;SHEN Jianling;LIU Yan;LIU Ting;LI Huiying(Dept.of Pharmacy,Kunming Children’s Hospital/the Affiliated Children’s Hospital of Kunming Medical University,Kunming 650228,China;School of Pharmacy,Kunming Medical University,Kunming 650500,China)

机构地区：[1]昆明市儿童医院/昆明医科大学附属儿童医院药剂科,昆明650228 [2]昆明医科大学药学院,昆明650500

出　　处：《中国药房》2023年第17期2154-2161,共8页China Pharmacy

基　　金：云南省卫生科技计划项目(No.2018NS0174);昆明市卫生科技人才培养项目[No.2023-SW(技)-19]。

摘　　要：目的 探讨不同剂量锌治疗儿童腹泻的有效性和安全性,为临床合理用药提供参考。方法 计算机检索PubMed、Cochrane Library、Embase数据库中有关锌(锌组)对比安慰剂和或常规治疗等(对照组)治疗儿童腹泻的随机对照试验(RCT),检索时限为建库起至2022年10月,参考Cochrane Handbook 6.0对纳入的文献进行质量评价,并采用RevMan 5.3软件进行Meta分析和敏感性分析。结果 最终纳入25项RCT,共8 618例患儿。Meta分析结果显示,在腹泻持续时间方面,锌元素<20 mg组中,锌组患儿腹泻持续时间显著短于对照组[SMD=-0.39,95%CI(-0.71,-0.08),P=0.01],但在年龄<6个月的亚组中,两组间差异无统计学意义[SMD=0.01,95%CI(-0.10,0.11),P=0.88];锌元素20 mg组中,锌组患儿腹泻持续时间显著短于对照组[SMD=-0.52,95%CI(-0.80,-0.23),P=0.000 3];锌元素>20 mg组中,锌组患儿腹泻持续时间显著短于对照组[SMD=-0.83,95%CI(-1.39,-0.27),P=0.004];年龄≤12个月时锌>10 mg或年龄>12个月时锌>20 mg组(简称“等剂量组”)中,锌组患儿腹泻持续时间显著短于对照组[SMD=-0.16,95%CI(-0.27,-0.06),P=0.003]。在治疗7 d后腹泻率方面,锌组和对照组治疗7 d后腹泻率的差异均无统计学意义:锌元素<20 mg组[OR=1.28,95%CI(0.96,1.70),P=0.09],锌元素20 mg组[OR=0.40,95%CI(0.15,1.01),P=0.05],等剂量组[OR=0.64,95%CI(0.28,1.44),P=0.28]。在呕吐率方面,锌元素<20 mg组中,锌组患儿呕吐率显著高于对照组[OR=2.13,95%CI(1.68,2.70),P<0.001];等剂量组中,锌组患儿呕吐率显著高于对照组[OR=1.84,95%CI(1.44,2.34),P<0.001];锌元素20 mg组和>20 mg组中,锌组和对照组患儿呕吐率的差异无统计学意义(P>0.05)。敏感性分析结果均无翻转。结论 锌可显著缩短患儿(6个月及以上)腹泻持续时间,但低剂量(<20 mg)就有增加呕吐的风险,临床应予以重视。OBJECTIVE To investigate the efficacy and safety of different doses of zinc in the treatment of diarrhea in children,and to provide a reference for clinical safe and rational drug use.METHODS Retrieved from PubMed,Cochrane Library,Embase database,randomized controlled trials about zinc(zinc group) versus placebo or conventional treatment(control group) in the treatment of diarrhea in children were collected from the inception to October 2022.Then,the quality of the included literature was evaluated by the Cochrane Handbook 6.0,and meta-analysis and sensitivity analysis were performed by RevMan 5.3software.RESULTS Finally,25 RCTs were included,with a total of 8 618 children.The results of meta-analysis showed that in terms of duration of diarrhea,in zinc <20 mg group,the zinc group was significantly shorter than the control group [SMD=-0.39,95%CI(-0.71,-0.08),P=0.01],but in subgroups of <6 months old,there was no significant difference between the two groups [SMD=0.01,95%CI(-0.10,0.11),P=0.88].In zinc 20 mg group,the zinc group was significantly shorter than the control group [SMD=-0.52,95%CI(-0.80,-0.23),P=0.000 3].In zinc >20 mg group,the zinc group was significantly shorter than the control group [SMD=-0.83,95%CI(-1.39,-0.27),P=0.004].In zinc >10 mg(age ≤12 months) or zinc >20 mg(age >12 months) group(short for “constant dose group”),the zinc group was significantly shorter than the control group [SMD=-0.16,95%CI(-0.27,-0.06),P=0.003].In the aspect of diarrhea rate after 7 days of treatment,there was no significant difference in the diarrhea rate after 7 days of treatment between the zinc group and the control group:in zinc <20 mg group[OR=1.28,95%CI(0.96,1.70),P=0.09],in zinc 20 mg group [OR=0.40,95%CI(0.15,1.01),P=0.05],in constant dose group [OR=0.64,95%CI(0.28,1.44),P=0.28].In terms of vomiting rate,in zinc <20 mg group,the vomiting rate of zinc group was significantly higher than that of the control group [OR=2.13,95%CI(1.68,2.70),P<0.001];in constant dose group,vomiting rate of zinc group was signif

关 键 词：锌 剂量 腹泻 腹泻持续时间 呕吐 META分析 

分 类 号：R969.3[医药卫生—药理学]