鋅減少肺炎病童的死亡率


  【24drs.com】非洲的一篇研究中,6-59個月的嚴重肺炎孩童,除了標準的抗生素,再多給予鋅製劑時,死亡率降低;此外,HIV感染病童的死亡率降低幅度大於HIV陰性者。
  
  作者們結論指出,基於這些結果,可以考慮將鋅用於嚴重肺炎的輔助治療,特別是未曾接受過高活性抗逆轉錄病毒治療的HIV病童。
  
  研究者表示,急性呼吸道感染是5歲以下幼童最常見的發病與死亡原因,開發中國家急性下呼吸道感染的負擔是已開發國家的2-10倍。
  
  作者們指出,鋅補充劑用於這類患者的結果各異,孟加拉的一篇隨機控制研究顯示鋅輔助治療促進嚴重肺炎病童的恢復,但是其他研究顯示無效,而沒有研究評估鋅輔助治療對於致命小兒肺炎的影響。
  
  為了評估這個議題,研究者隨機分派6-59個月大的嚴重肺炎孩童每天接受一次鋅製劑,為期7天(n = 176人;12個月以上孩童的劑量為20 mg、12個月以下的則是10 mg),或者每天接受一次安慰劑,為期7天(n = 176人)。
  
  這些孩童也接受嚴重肺炎的標準抗生素治療,每6小時評估他們的氧氣飽和度、呼吸速率和體溫。
  
  給予鋅製劑的孩童中,死亡的有7人 (4.0%),安慰劑組則有21人(11.9%)死亡;這表示鋅補充品降低了近70%的死亡率風險(相對風險[RR]降低值為0.67;95%信心區間[CI]為0.24 - 0.85)。
  
  HIV感染孩童的風險降低最多,HIV病童中,安慰劑組的27人有7人致命,鋅製劑組的28人則無人死亡(RR,0.1;95% CI,0.0 - 1.0)。
  
  相對的,未感染HIV的孩童中,鋅製劑組和安慰劑組的致命案例沒有差異,安慰劑組為7/127 (5.5%),未感染HIV而有接受鋅製劑的孩童則是5/129 (3.9%)(RR,0.7;95% CI,0.2 - 2.2)。
  
  根據研究者指出,HIV陽性孩童的安慰劑額外風險高於HIV陰性孩童(絕對風險降低值分別是26/100與2/100;P = .006)。他們估計,治療13個病患可以避免1例死亡,接受安慰劑孩童的死亡率為接受鋅製劑者的3倍。
  
  作者們結論指出,這篇研究有兩個關鍵結果,整體而言,鋅補充品使這些孩童的死亡率顯著下降,但是並未減少疾病嚴重度參數回復到正常化的時間。
  
  研究者表示,鋅補充品或許因為加強HIV陽性病患的T淋巴球吞噬作用和避免細胞凋亡而增加了免疫反應;鋅缺乏(佔此類病童的20%-69%)時會因為一系列的機轉而影響免疫力,例如T細胞失能、細胞內殺手細胞失調。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6725&x_classno=0&x_chkdelpoint=Y
  
  

Zinc Decreases Mortality in Children With Pneumonia

By Emma Hitt, PhD
Medscape Medical News

February 8, 2012 — In a study conducted in Africa, children aged 6 to 59 months who had severe pneumonia had reduced mortality when receiving zinc in addition to standard antibiotics, a new study has found. In addition, the reduction in mortality was greater among HIV-infected than non-HIV-infected children.

Maheswari G. Srinivasan, from the Department of Pediatrics and Child Health at the School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, and colleagues reported the findings in an article published online February 8 in BMC Medicine.

"Given these results, zinc could be considered for use as adjunct therapy for severe pneumonia, especially among Highly Active Antiretroviral Therapy naive HIV infected children in our environment," the authors conclude.

According to the researchers, acute respiratory tract infections is the most common cause of morbidity and mortality in children younger than 5 years of age, and the "burden of acute lower respiratory tract infections is 2 to 10 times more common in developing than in developed countries."

The results with zinc supplementation in this setting have been mixed. "One randomized controlled study from Bangladesh showed that zinc adjunct therapy accelerated recovery of children with severe pneumonia," the authors note, "but other studies have shown no effect," and "no studies have assessed the impact of zinc adjunct therapy on case fatality of children with pneumonia."

To evaluate this issue, the researchers randomly assigned children aged 6 to 59 months who had severe pneumonia to receive either zinc once daily for 7 days (n = 176; 20 mg for children aged 12 months or older and 10 mg for younger children) or a placebo once daily for 7 days (n = 176).

Children also received standard antibiotics for severe pneumonia and were assessed every 6 hours for oxygen saturation, respiratory rate, and temperature.

Among the children receiving zinc, 7 (4.0%) died compared with 21 patients (11.9%) in the placebo group. This represented nearly a 70% reduction in mortality risk in favor of zinc supplementation (relative risk [RR] reduction, 0.67; 95% confidence interval [CI], 0.24 - 0.85).

The greatest risk reduction was seen in HIV-infected children. Among HIV-infected children, case fatality was 7 of 27 children in the placebo group vs 0 of 28 children in the zinc group (RR, 0.1; 95% CI, 0.0 - 1.0).

In contrast, in HIV-uninfected children, no difference in case fatality was observed with zinc vs placebo: case fatality was 7/127 (5.5%) with placebo vs 5/129 (3.9%) among HIV-uninfected children receiving zinc (RR, 0.7; 95% CI, 0.2 - 2.2).

According to the researchers, the excess risk with placebo was substantially greater among HIV-positive children than in HIV-negative children (absolute risk reduction, 26/100 children vs 2/100 children, respectively; P = .006).

They estimated that 13 patients needed to be treated to avert 1 death, and that children who received the placebo were 3 times more likely to die compared with those who received zinc.

"There are two key findings in this study: overall, zinc supplementation in these children significantly decreased case fatality, but did not reduce the time to normalization of the parameters for disease severity," the authors conclude.

According to the researchers, zinc supplementation might increase the immune response by boosting phagocytosis and averting apoptosis of T lymphocytes in HIV-infected patients.

They add that zinc deficiency (present in from 20% to 69% of children in this setting) "compromises immunity through a number of mechanisms, such as T cell dysfunction and dysregulation of intracellular killing."

The authors have disclosed no relevant financial relationships.

BMC Medicine. Published online February 8, 2012.

    
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