锌剂剂量差异对轮状病毒性肠炎患儿血清炎性因子及心肌损伤的影响

Effect of zinc dose difference on serum inflammatory factors and myocardial injury in children with rotavirus enteritis

目的研究锌剂剂量差异对轮状病毒性肠炎患儿近期疗效、血清炎性因子、心肌损伤及复发率的影响.方法选择2014-01/2016-12在天津市宁河区医院治疗的轮状病毒肠炎患儿500例.用随机数表法分为对照组和观察组,每组各250例,在常规治疗的基础上,对照组给予低剂量甘草锌治疗,观察组给予高剂量甘草锌治疗.比较两组患儿的疗效、心肌酶谱、炎症因子水平和复发率.结果观察组患儿显效167例(66.80%),有效59例(23.60%),总有效率为90.40%,对照组患儿的总有效率为71.20%(P<0.05).治疗前两组患儿的血清炎症因子水平相近(P>0.05),治疗后两组患儿的肿瘤坏死因子-α、白介素(interleukin,IL)-6、IL-8和核因子-k B水平均明显下降,观察组患儿的血清炎症因子水平低于对照组(P<0.05).治疗前两组患儿的心肌酶谱水平相近(P>0.05),治疗后两组患儿的肌酸激酶(creatine kinase,CK)、CK-MB、乳酸脱氢酶和谷草转氨酶水平均明显下降,观察组患儿的心肌酶谱水平低于对照组(P<0.05).随访6 mo后,观察组患儿有21例再次发生腹泻,复发率为8.40%,对照组患儿有49例再次发生腹泻,复发率为19.60%,差异有统计学意义(χ~2=13.023,P<0.05).结论补锌治疗可以明显改善轮状病毒肠炎患儿的临床症状,提高疗效,改善患儿的心肌酶谱和炎症因子水平,复发率低,高剂量补锌效果更佳,应根据患儿的具体情况选用适宜剂量.

AIM To evaluate the effect of zinc dose difference on the short-term curative effect, serum inflammatoryfactors, myocardial damage, and recurrence rate in children with rotavirus enteritis.METHODS Five hundred children with rotavirus enteritis treated at our hospital from January 2014 to December 2016 were selected. They were randomly divided into either a control group or an observation group, with 250 cases in each group. The control group was given a low dose of licorice zinc on the basis of conventional treatment, and the observation group was given a high dose of licorice zinc treatment on the basis of conventional treatment. The curative effect, myocardial enzymes, inflammatory factors, and recurrence rate were compared between the two groups.RESULTS The total effective rate was significantly higher in the observation group than in the control group（90.40% vs 71.20%, P 0.05）. The levels of serum inflammatory factors in the two groups were similar before treatment. After treatment, TNF-α, IL-6, IL-8, and NF-k B levels were significantly decreased in both groups（P 0.05）, and the decrease was more significant in the observation group than in the control group（P 0.05）. Before treatment, myocardial enzyme levels were similar between the two groups. After treatment, creatine kinase（CK）, CK-MB, lactate dehydrogenase, and aspartate transaminase were significantly decreased（P 0.05）, and the decrease was more significant in the treatment group than in the control group（P 0.05）. During 6 mo of follow-up, the recurrence rate was significantly lower in theobservation group than in the control group（8.40% vs 19.60%, χ~2 = 13.023, P 0.05）.CONCLUSION Zinc supplementation therapy can obviously improve clinical symptoms, increase the curative effect, improve myocardial enzyme and inflammatory factor levels, and reduce recurrence rate in children with rotavirus enteritis, with high dose zinc supplementation having better effects.