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

TU Caixia; REN Danyang; LI Yunwei; YANG Yanming; SHEN Jianling; LIU Yan; LIU Ting; LI Huiying

doi:10.6039/j.issn.1001-0408.2023.17.19

您当前的位置：

首页 >

文章列表页 >

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

更新时间：2023-09-14

- Efficacy and safety of different doses of zinc in the treatment of diarrhea in children： a systematic review
- ZHONGGUO YAOFANG Vol. 34, Issue 17, Pages: 2154-2161(2023)
- 作者机构：
  
  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
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.17.19
  CLC： R969.3
- Published：15 September 2023，
  
  Received：18 February 2023，
  
  Revised：28 June 2023，
扫描看全文
涂彩霞,任丹阳,李云巍等.不同剂量锌治疗儿童腹泻有效性和安全性的系统评价 ^Δ[J].中国药房,2023,34(17):2154-2161.

TU Caixia,REN Danyang,LI Yunwei,et al.Efficacy and safety of different doses of zinc in the treatment of diarrhea in children： a systematic review[J].ZHONGGUO YAOFANG,2023,34(17):2154-2161.
涂彩霞,任丹阳,李云巍等.不同剂量锌治疗儿童腹泻有效性和安全性的系统评价 ^Δ[J].中国药房,2023,34(17):2154-2161. DOI： 10.6039/j.issn.1001-0408.2023.17.19.

TU Caixia,REN Danyang,LI Yunwei,et al.Efficacy and safety of different doses of zinc in the treatment of diarrhea in children： a systematic review[J].ZHONGGUO YAOFANG,2023,34(17):2154-2161. DOI： 10.6039/j.issn.1001-0408.2023.17.19.

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），

＝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），

＝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），

＝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），

＝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），

＝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），

＝0.09]，锌元素20 mg组[OR＝0.40，95%CI（0.15，1.01），

＝0.05]，等剂量组[OR＝0.64，95%CI（0.28，1.44），

＝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），

＜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），

＜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（

＞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。

Abstract

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 5.3 software.

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），

＝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），

＝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），

＝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），

＝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），

＝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），

＝0.09]， in zinc 20 mg group [OR＝0.40， 95%CI （0.15，1.01），

＝0.05]， in constant dose group [OR＝0.64， 95%CI （0.28， 1.44），

＝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），

＜0.001]； in constant dose group， vomiting rate of zinc group was significantly higher than that of the control group [OR＝1.84， 95%CI （1.44， 2.34），

＜0.001].

CONCLUSIONS

Zinc can significantly shorten the duration of diarrhea in children（6 months and above）， but low doses can increase the risk of vomiting， which should be taken attention in clinical.

关键词

锌剂量腹泻腹泻持续时间呕吐Meta分析

Keywords

dosediarrheaduration of diarrheavomitingmeta-analysis

references

RERKSUPPAPHOL L，RERKSUPPAPHOL S. Efficacy of zinc supplementation in the management of acute diarrhoea： a randomised controlled trial[J]. Paediatr Int Child Health，2020，40（2）： 105-110.

YAZAR A S，GÜVEN Ş，DINLEYICI E Ç. Effects of zinc or synbiotic on the duration of diarrhea in children with acute infectious diarrhea[J]. Turk J Gastroenterol，2016，27（6）： 537-540.

LAZZERINI M，WANZIRA H. Oral zinc for treating diarrhoea in children[J]. Cochrane Database Syst Rev，2016，12（12）： CD005436.

DHINGRA U，KISENGE R，SUDFELD C R，et al. Lower-dose zinc for childhood diarrhea：a randomized，multicenter trial[J]. N Engl J Med，2020，383（13）： 1231-1241.

BARFFOUR M A，HINNOUHO G M，WESSELLS K R，et al. Effects of therapeutic zinc supplementation for diarrhea and two preventive zinc supplementation regimens on the incidence and duration of diarrhea and acute respiratory tract infections in rural Laotian children： a rando- mized controlled trial[J]. J Glob Health，2020，10（1）： 010424.

倪鑫，王宝西，王荃，等. 儿童急性感染性腹泻病诊疗规范：2020年版[J]. 中国医药科学，2020，10（21）： 249-256.

HIGGINS J，THOMAS J，CHANDLER J，et al.Cochrane handbook for systematic reviews of interventions[EB/OL].[2022-07-10].https：//training.cochrane.org/handbook/archive/v6https://training.cochrane.org/handbook/archive/v6.

罗德惠，万翔，刘际明，等. 如何实现从样本量、中位数、极值或四分位数到均数与标准差的转换[J]. 中国循证医学杂志，2017，17（11）： 1350-1356.

FISCHER WALKER C L，BHUTTA Z A，BHANDARI N，et al. Zinc supplementation for the treatment of diarrhea in infants in Pakistan，India and Ethiopia[J]. J Pediatr Gastroenterol Nutr，2006，43（3）： 357-363.

GREGORIO G V，DANS L F，CORDERO C P，et al. Zinc supplementation reduced cost and duration of acute diarrhea in children[J]. J Clin Epidemiol，2007，60（6）： 560-566.

CRISINEL P A，VERGA M E，KOUAME K S，et al. Demonstration of the effectiveness of zinc in diarrhoea of children living in Switzerland[J]. Eur J Pediatr，2015，174（8）： 1061-1067.

PATRO B，SZYMAŃSKI H，SZAJEWSKA H. Oral zinc for the treatment of acute gastroenteritis in Polish children： a randomized，double-blind，placebo-controlled trial[J]. J Pediatr，2010，157（6）： 984-988.e1.

DALGIC N，SANCAR M，BAYRAKTAR B，et al. Probio-tic，zinc and lactose-free formula in children with rotavirus diarrhea： are they effective?[J]. Pediatr Int，2011，53（5）： 677-682.

BROOKS W A，SANTOSHAM M，ROY S K，et al. Efficacy of zinc in young infants with acute watery diarrhea[J]. Am J Clin Nutr，2005，82（3）： 605-610.

DUTTA P，MITRA U，DUTTA S，et al. Zinc，vitamin A，and micronutrient supplementation in children with diarrhea： a randomized controlled clinical trial of combination therapy versus monotherapy[J]. J Pediatr，2011，159（4）： 633-637.

POLAT T B，UYSALOL M，CETINKAYA F. Efficacy of zinc supplementation on the severity and duration of diarrhea in malnourished Turkish children[J]. Pediatr Int，2003，45（5）： 555-559.

ROY S K，TOMKINS A M，AKRAMUZZAMAN S M，et al. Randomised controlled trial of zinc supplementation in malnourished Bangladeshi children with acute diarrhoea[J]. Arch Dis Child，1997，77（3）： 196-200.

ROY S K，TOMKINS A M，MAHALANABIS D，et al. Impact of zinc supplementation on persistent diarrhoea in malnourished Bangladeshi children[J]. Acta Paediatr，1998，87（12）： 1235-1239.

BAQUI A H，BLACK R E，ARIFEEN S E，et al. Effect of zinc supplementation started during diarrhoea on morbi- dity and mortality in Bangladeshi children： community randomised trial[J]. BMJ，2002，325（7372）： 1059.

SACHDEV H P，MITTAL N K，YADAV H S. Oral zinc supplementation in persistent diarrhoea in infants[J]. Ann Trop Paediatr，1990，10（1）： 63-69.

ROY S K，HOSSAIN M J，KHATUN W，et al. Zinc supplementation in children with cholera in Bangladesh： randomised controlled trial[J]. BMJ，2008，336（7638）： 266-268.

SACHDEV H P，MITTAL N K，MITTAL S K，et al. A controlled trial on utility of oral zinc supplementation in acute dehydrating diarrhea in infants[J]. J Pediatr Ga- stroenterol Nutr，1988，7（6）： 877-881.

DUTTA P，MITRA U，DATTA A，et al. Impact of zinc supplementation in malnourished children with acute watery diarrhoea[J]. J Trop Pediatr，2000，46（5）： 259-263.

AL-SONBOLI N，GURGEL R Q，SHENKIN A，et al. Zinc supplementation in Brazilian children with acute diarrhoea[J]. Ann Trop Paediatr，2003，23（1）： 3-8.

BHATNAGAR S，BAHL R，SHARMA P K，et al. Zinc with oral rehydration therapy reduces stool output and duration of diarrhea in hospitalized children： a randomized controlled trial[J]. J Pediatr Gastroenterol Nutr，2004，38（1）： 34-40.

BORAN P，TOKUC G，VAGAS E，et al. Impact of zinc supplementation in children with acute diarrhoea in Turkey[J]. Arch Dis Child，2006，91（4）： 296-299.

BAHL R，BHANDARI N，SAKSENA M，et al. Efficacy of zinc-fortified oral rehydration solution in 6- to 35-month-old children with acute diarrhea[J]. J Pediatr，2002，141（5）： 677-682.

SAZAWAL S，BLACK R E，BHAN M K，et al. Zinc supplementation in young children with acute diarrhea in India[J]. N Engl J Med，1995，333（13）： 839-844.

VALERY P C，TORZILLO P J，BOYCE N C，et al. Zinc and vitamin A supplementation in Australian indigenous children with acute diarrhoea： a randomised controlled trial[J]. Med J Aust，2005，182（10）： 530-535.

LARSON C P，HOQUE A B，LARSON C P，et al. Initiation of zinc treatment for acute childhood diarrhoea and risk for vomiting or regurgitation： a randomized，double-blind，placebo-controlled trial[J]. J Health Popul Nutr，2005，23（4）： 311-319.

STRAND T A，CHANDYO R K，BAHL R，et al. Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children[J]. Pediatrics，2002，109（5）： 898-903.

贺会学. 赖氨葡锌颗粒联合双歧杆菌四连活菌片治疗小儿腹泻的疗效[J]. 实用中西医结合临床，2021，21（2）： 93-94，98.

龙松清. 赖氨葡锌联合酪酸梭菌活菌片对腹泻患儿的疗效影响[J]. 医学理论与实践，2021，34（7）： 1193-1194.

陶敏.不同剂量锌剂联合培菲康治疗小儿轮状病毒性肠炎的临床疗效及对炎性因子水平的影响[J].养生保健指南，2018，10（40）：55.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Effects of ivabradine on vascular endothelial function in patients with coronary artery disease： a meta-analysis

Meta-analysis about ADRB1 Arg389Gly polymorphism on the efficacy of bisoprolol

Meta-analysis of efficacy and safety of aspirin versus other anticoagulants in the prevention of thromboembolism after orthopedic surgery

Meta-analysis of the efficacy and safety of Saccharomyces boulardii versus Bifidobacterium triple live bacteria in the treatment of pediatric diarrhea

Systematic review and meta-analysis of health state utility for global patients with hemophilia

Related Author

CHEN Congling

YANG Xian

WU Han

YING Jiachen

ZHANG Ruobin

LAN Xi

ZHANG Jinping

ZHANG Tianqi

Related Institution

Dept. of Cardiology， Nanjing Drum Tower Hospital

School of Basic Medicine and Clinical Pharmacy， China Pharmaceutical University

Dept. of Pharmacy， Nanjing Drum Tower Hospital

Dept. of Pharmacy， Beijing Hospital/National Center of Gerontology/Institute of Geriatric Medicine， Chinese Academy of Medical Science/Beijing Key Laboratory of Assessment for Clinical Risk and Individual Application of Drugs

Dept. of Cardiology， General Hospital of Eastern Theater Command

Address：8/F,129 Daping Main Street,Yuzhong District,Chongqing 400042,P.R.China
Technical support is provided by Beijing Founder Electronics co., LTD 渝ICP备15012710号公网安备50010302001817
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰