迁延性腹泻患儿的体液免疫、血清锌水平分析及口服葡萄糖酸锌的疗效研究

Analysis of humoral immunity and serum zinc levels in children with persistent diarrhea and study on the efficacy of oral zinc gluconate

目的 观察迁延性腹泻患儿的体液免疫、血清锌水平,并探究口服葡萄糖酸锌对其血清锌、体液免疫功能及疾病复发的影响。方法 选择96例迁延性腹泻患儿作为病例组,按就诊顺序随机分为葡萄糖酸锌组和常规组,每组48例。常规组给予对症治疗,葡萄糖酸锌组在常规组基础上口服葡萄糖酸锌口服液。另纳入50例体检正常儿童作为健康对照组。比较健康对照组和病例组血清锌与免疫球蛋白[免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)]水平,葡萄糖酸锌组和常规组临床疗效、治疗前后血清锌与免疫球蛋白水平及大便次数复常时间、大便性状复常时间、随访3个月腹泻复发情况。结果 病例组血清锌、IgA、IgM、IgG分别为(52.72±8.13)μmol/L、(0.651±0.252)g/L、(0.725±0.236)g/L、(5.165±1.436)g/L,均低于健康对照组的(70.27±8.76)μmol/L、(1.502±0.356)g/L、(1.814±0.631)g/L、(11.258±1.641)g/L,差异有统计学意义(P<0.05)。葡萄糖酸锌组临床总有效率为93.75%(45/48),显著高于常规组的75.00%(36/48),差异具有统计学意义(P<0.05)。治疗后,葡萄糖酸锌组血清锌、IgA、IgM、IgG分别为(68.24±8.05)μmol/L、(1.114±0.343)g/L、(1.424±0.602)g/L、(9.847±1.552)g/L,高于本组治疗前的(52.58±8.21)μmol/L、(0.658±0.263)g/L、(0.729±0.232)g/L、(5.211±1.422)g/L和常规组治疗后的(55.25±8.42)μmol/L、(0.678±0.246)g/L、(0.763±0.218)g/L、(5.425±1.466)g/L,差异具有统计学意义(P<0.05)。常规组治疗前后血清锌、IgA、IgM、IgG水平比较差异无统计学意义(P>0.05)。葡萄糖酸锌组的大便次数复常时间(6.7±2.0)d、大便性状复常时间(7.5±3.2)d均短于常规组的(9.9±3.1)、(11.3±2.8)d,随访3个月腹泻复发率2.08%(1/48)低于常规组的14.58%(7/48),差异具有统计学意义(P<0.05)。结论 迁延性腹泻患儿存在缺锌和体液免疫紊乱情况,口服葡萄糖酸锌能够快速升高患儿体内血清锌水平,纠正免疫功能紊乱,有助于缩短病程及降低复发率。

Objective To observe the levels of humoral immunity and serum zinc in children with persistent diarrhea,and explore the effect of oral zinc gluconate on serum zinc,humoral immune function and disease recurrence.Methods A total of 96 children with persistent diarrhea were selected as case group and randomly divided into zinc gluconate group and conventional group according to the order of treatment,with 48 cases in each group.The conventional group was given symptomatic treatment,and the zinc gluconate group was given zinc gluconate solution on the basis of the conventional group.In addition,50 children with normal physical examination were included as healthy control group.Comparison was made on levels of serum zinc and immunoglobulin[immunoglobulin A(IgA),immunoglobulin M(IgM),immunoglobulin G(IgG)]between the healthy control group and the case group,as well as clinical efficacy,serum zinc and immunoglobulin levels before and after treatment,recovery time of stool frequency,recovery time of stool property,and recurrence of diarrhea after 3 months of follow-up between the zinc gluconate group and the conventional group.Results The serum zinc,IgA,IgM and IgG in the case group were(52.72±8.13)μmol/L,(0.651±0.252)g/L,(0.725±0.236)g/L and(5.165±1.436)g/L,which were lower than those of(70.27±8.76)μmol/L,(1.502±0.356)g/L,(1.814±0.631)g/L and(11.258±1.641)g/L in the healthy control group,and the differences were statistically significant(P<0.05).The total clinical effective rate of the zinc gluconate group was 93.75%(45/48),which was significantly higher than that of 75.00%(36/48)of the conventional group,and the difference was statistically significant(P<0.05).After treatment,the serum zinc,IgA,IgM and IgG in the zinc gluconate group were(68.24±8.05)μmol/L,(1.114±0.343)g/L,(1.424±0.602)g/L and(9.847±1.552)g/L,which were higher than those of(52.58±8.21)μmol/L,(0.658±0.263)g/L,(0.729±0.232)g/L and(5.211±1.422)g/L before treatment in this group,and those of(55.25±8.42)μmol/L,(0.678±0.246)g/L,(0.763±0.218)g/L and(5.425±1.466)g/L after treatment in the conventional group.The differences were statistically significant(P<0.05).There was no statistically significant difference in serum levels of zinc,IgA,IgM and IgG in the conventional group before and after treatment(P>0.05).The zinc gluconate group had recovery time of stool frequency of(6.7±2.0)d and recovery time of stool property of(7.5±3.2)d,which were shorter than those of(9.9±3.1)and(11.3±2.8)d in the conventional group;the diarrhea recurrence rate of 2.08%(1/48)in the zinc gluconate group after 3 months of follow-up was lower than that of 14.58%(7/48)in the conventional group;the differences were statistically significant(P<0.05).Conclusion Zinc deficiency and humoral immune disorder exist in children with persistent diarrhea.Oral administration of zinc gluconate can rapidly increase the serum zinc level in children,correct the immune dysfunction,and help shorten the course of disease and reduce the recurrence rate.