小儿轮状病毒肠炎血锌水平变化及补锌治疗

目的探讨小儿轮状病毒（RV）肠炎血清锌水平的变化及在常规治疗的基础上佐以补锌治疗对RV肠炎的疗效和发病后3月内腹泻发生率的影响.方法收集1183例健康儿静脉空腹血清,按年龄（6月~3岁）分组将所得血清值作为东莞地区该年龄段儿童血锌正常值（正常对照组）;收集近2 a 172例门诊确诊为RV肠炎患儿的临床资料,172例随机分为两组,补锌治疗组92例和对照组80例（按年龄分段）.以正常对照组为对照;观察RV肠炎患病初时血清锌水平;补锌治疗组在常规治疗的基础上加用口服葡萄糖酸锌片,比较两组的疗效及补锌治疗组治疗前、后的血锌水平变化,评价补锌辅助治疗RV肠炎的临床意义.电话跟踪两组患儿3个月内腹泻的再发情况,分析补锌对于腹泻再发的预防作用.结果 RV肠炎患儿血锌明显低于正常对照组血锌水平,差异有统计学意义（P〈0.01）;补锌治疗组总有效率94.6%,明显高于对照组的83.7%,疗效比较两组差异有统计学意义（P〈0.01）;补锌治疗后治疗组血锌值与正常对照组比较差异无统计学意义（P〉0.051）.随访显示,3月内治疗组腹泻发生9人,发生率为9.8%（9/92）对照组腹泻发生为21人,发生率为26.2%（21/80）,差异有显著性.结论 RV肠炎患儿血清锌水平降低,在常规治疗的基础上佐以补锌对于提高RV肠炎的疗效有良好的作用.补锌治疗后,RV肠炎患儿血清锌水平基本恢复正常.随访显示保持血锌水平的正常对减少发病后3月内腹泻的发生率有一定的作用.说明WHO推荐补锌的剂量和疗程同样适合中国小儿RV肠炎的辅助治疗.

Serum Zinc Levels and Zinc Supplementation Treatment of Young Children with Rotaviral Enteritis

Objective To evaluate the changes of serum zinc levels of children with rotaviral enteritis,the efficacy of zinc supplementation treatment besides conventional therapy,and the influence of zinc treatment on diarrhea recurrence rate within 3 months.Methods All 1183 healthy children enrolled in this study were divided into groups by ages,and the fasting serum Zn levels of them were defined as normal levels of children in Dongguan.All 172 children patients with confirmed rotaviral enteritis in recent two years were enrolled,and they were randomly divided into two groups：92 in Zinc treatment group（TG）,and 80 in control group（age was used as subsection）.Using the normal serum zinc levels of healthy children in Dongguan as standard,the serum zinc levels of children with RV enteritis were observed.In addition to conventional therapy,zinc gluconate was given to children patients in TG group,the diffenent efficacy between the two groups and the changes of serum zinc levels before and after zinc treatment in TG,then the clinical significance of zinc supplementation treatment was evaluated.Children in the two groups were followed up by telephone to learn the recurrence of diarrhea in three months,and the prevention of zinc supplementation treatment on the recurrence of diarrhea was analyzed.Results The serum zinc levels of children with rotaviral enteritis were significantly lower than normal children（P0.01）.The total effective rate was significantly higher in TG than that in control group（94.6% vs.83.7%,P0.01）.After Zinc treatment,there was no significant difference in the serum zinc levels between TG and control gorup（P0.05）.Follow-up by telephone indicated that 6 cases in TG recurred in three months,the incidence was 9.8%（9/92）,17 cases in the control group recurred in three months,the incidence was 26.2%（21/80）,there was a significant difference between the two groups.Conclusions The serum Zinc levels of children with rotaviral enteritis are decreased.In addition to diarrhea conventional therapy,giving Zinc treatment has better effect on enhancing curative effect of Rota-Viral Enteritis.Serum Zinc levels of young children with rotaviral enteritis can recover to normal levels after giving Zinc treatment.Follow-up indicates that maintaining normal levels of serum Zinc has definited effect on preventing diarrhea recurrence within 3 months after onset.Zinc supplement protocols made by WHO is suitable for chinese children with rotaviral enteritis.