补锌联合消旋卡多曲治疗小儿轮状病毒性肠炎中的临床疗效及对血浆TNF-α、IL-6、IL-17水平的影响

Clinical Efficacy of Zinc Supplementation Combined with Racecadotril in the Treatment of Children with Rotavirus Enteritis and Its Effects on the Plasma TNF-α, IL-6 and IL-17 Concentrations

目的:探讨补锌联合消旋卡多曲治疗小儿轮状病毒性肠炎的临床疗效及对血浆肿瘤坏死因子(TNF)-α、白介素(IL)IL-6、IL-17水平的影响。方法:选择2015年3月至2017年3月我院接诊的96例轮状病毒性肠炎患儿为研究对象,通过随机数表法分为观察组(n=48)和对照组(n=48)。对照组在常规治疗基础上给予消旋卡多曲颗粒治疗,观察组在常规治疗基础上联合葡萄糖酸锌片治疗,两组均连续治疗7d。比较两组治疗前后血浆TNF-α、IL-6、IL-17水平的变化,治疗后第3d、5d、7d时的病毒转阴率,症状好转时间、住院时间及临床疗效。结果:治疗后,两组血浆TNF-α、IL-6、IL-17水平均较治疗前显著降低(P<0.05),且观察组血浆TNF-α、IL-6、IL-17水平明显低于对照组[(29.45±3.12)ng/L vs.(47.83±3.91)ng/L,(24.56±3.05)μg/L vs.(36.12±3.28)μg/L,(9.74±1.14)pg/ml vs.(18.45±2.02)pg/ml](P<0.05)。观察组在第3d、5d、7d时的病毒转阴率均明显高于对照组[56.25%(27/48)vs.29.17%(14/48),72.92%(35/48)vs.50.00%(24/48),95.83%(46/48)vs.75.00%(36/48)](P<0.05)。观察组止吐时间、止泻时间、退热时间、大便性状恢复时间及住院时间均明显比对照组短[(1.28±0.30)d vs.(2.34±0.38)d,(2.12±0.32)d vs.(3.53±0.40)d,(1.23±0.25)d vs.(2.45±0.32)d,(2.07±0.30)d vs.(3.12±0.36)d,(4.85±0.56)d vs.(6.13±0.70)d](P<0.05);观察组临床疗效总有效率明显高于对照组[93.75%(45/48)vs.70.83%(34/48)](P<0.05)。结论:补锌联合消旋卡多曲治疗轮状病毒性肠炎患儿的临床效果明显优于消旋卡多曲颗粒治疗,其可有效缓解临床症状,可能与有效降低血浆TNF-α、IL-6、IL-17的水平相关。

Objective： To study the clinical efficacy of zinc supplementation combined with racecadotril in the treatment of rotavirus enteritis in children and its effects on the plasma tumor necrosis factor（TNF）-α, interleukin（IL）-6 and IL-17 concentrations.Methods： 96 cases of children with rotavirus enteritis who were treated from March 2015 to March 2017 in our hospital were selected.According to random number table, those patients were divided into the observation group（n=48） and the control group（n=48）. The control group was treated with racecadotril on the basis of conventional treatment, while the observation group was combined with zinc gluconate on the basis of conventional treatment, both groups were continuously treated of 7 d. The changes of plasma TNF-α, IL-6 and IL-17 concentrations in the two groups were compared before and after treatment, the negative rate of virus was compared at 3 d, 5 d and7 d after treatment, and the symptom improvement time, hospitalization time and clinical efficacy were compared. Results： After treatment, the plasma TNF-α, IL-6 and IL-17 concentrations in the two groups were significantly lower than those before treatment（P〈0.05）, and the plasma TNF-α, IL-6 and IL-17 concentrations in the observation group were significantly lower than those in the control group[（29.45±3.12）ng/L vs.（47.83±3.91）ng/L,（24.56±3.05）μg/L vs.（36.12±3.28）μg/L（9.74±1.14）pg/m L vs.（18.45±2.02）pg/m L]（P〈0.05）; the negative rate of virus at after treatment 3 d, 5 d and 7 d in the observation group was significantly higher than those in the control group [56.25%（27/48） vs. 29.17%（14/48）, 72.92%（35/48） vs. 50.00%（24/48）, 95.83%（46/48） vs. 75.00%（36/48）]（P〈0.05）; the antiemetic time, antidiarrheal time, antifebrile time, stool recovery time and hospitalization time in the observation group were significantly shorter than those in the control group[（1.28±0.30）d vs.（2.34±0.38）d,（2.12±0.32）d vs.（3.53±0.40）d,（1.23±0.25）d vs.（2.45±0.32）d,（2.07±0.30）d vs.（3.12±0.36）d,（4.85±0.56）d vs.（6.13±0.70）d]（P〈0.05）; the total effective rate in the observation group was significantly higher than those in the control group [93.75%（45/48） vs. 70.83%（34/48）]（P〈0.05）. Conclusion： The clinical effect of zinc supplementation combined with racecadotril was significantly better than racecadotril treatment, in the treatment of rotavirus enteritis in children, which could effectively alleviate the clinical symptoms, and may be related to effectively reduce the levels of plasma TNF-α, IL-6 and IL-17 concentrations.