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Những gì bổ sung kẽm đạt được và không đạt được trong việc ngăn ngừa tiêu chảy: một bài tổng quan có hệ thống và phân tích tổng hợp
Tóm tắt
Việc ngăn ngừa tiêu chảy đã đặt ra những thách thức không thể vượt qua. Một chiến lược phòng ngừa nhận được sự quan tâm đáng kể là bổ sung kẽm. Tài liệu hiện có, bao gồm các phân tích tổng hợp định lượng và các đánh giá hệ thống, có xu hướng cho thấy rằng việc bổ sung kẽm là có lợi, tuy nhiên bằng chứng ngược lại đang gia tăng. Do đó, chúng tôi đã tiến hành một phân tích tổng hợp cập nhật và toàn diện về tài liệu hiện có về tác động của bổ sung kẽm trong việc ngăn ngừa tiêu chảy. Các cơ sở dữ liệu EMBASE®, MEDLINE® và CINAHL® đã được tìm kiếm để thu thập các đánh giá và phân tích tổng hợp đã công bố về việc sử dụng bổ sung kẽm để phòng ngừa tiêu chảy ở trẻ em. Các thử nghiệm lâm sàng ngẫu nhiên (RCT) bổ sung được công bố sau các phân tích tổng hợp cũng đã được tìm kiếm. Tác động của việc bổ sung kẽm đối với năm kết quả sau được nghiên cứu: tỷ lệ mắc bệnh tiêu chảy, tỷ lệ phổ biến tiêu chảy, tỷ lệ tiêu chảy kéo dài, tỷ lệ kiết lỵ và tỷ lệ tử vong. Các RCT đã được công bố được kết hợp bằng cách sử dụng phân tích tổng hợp hiệu ứng ngẫu nhiên, phân tích tổng hợp theo nhóm, hồi quy tổng hợp, phân tích tổng hợp tích lũy và phân tích tổng hợp giới hạn để định lượng và mô tả vai trò của việc bổ sung kẽm với những kết quả đã nêu. Chúng tôi nhận thấy rằng bổ sung kẽm có mối liên hệ có lợi vừa phải (giảm 9%) với tỷ lệ mắc bệnh tiêu chảy, một mối liên hệ có lợi mạnh hơn (giảm 19%) với tỷ lệ phổ biến tiêu chảy và sự xuất hiện của nhiều lần tiêu chảy (giảm 28%), nhưng vẫn có sự không đồng nhất chưa được giải thích về mặt thống kê giữa các nghiên cứu cho những mối liên hệ này. Tuổi tác, lục địa nguồn gốc nghiên cứu, muối kẽm và rủi ro thiên lệch đã góp phần đáng kể vào sự không đồng nhất giữa các nghiên cứu. Việc bổ sung kẽm không cho thấy lợi ích có ý nghĩa thống kê trong việc giảm tỷ lệ mắc bệnh tiêu chảy kéo dài, kiết lỵ hay tỷ lệ tử vong. Trong hầu hết các trường hợp, khoảng tin cậy 95% cho các ước lượng tương đối nguy cơ tóm tắt đều bao trùm đơn vị. Lợi ích rõ ràng của việc bổ sung kẽm phòng ngừa được quan sát thấy đối với hai trong số năm kết quả liên quan đến tiêu chảy nhưng các khoảng tin cậy đều bao trùm đơn vị. Do đó, bằng chứng cho lợi ích phòng ngừa của kẽm chống lại tiêu chảy là không chắc chắn. Cần tiếp tục nỗ lực để hiểu rõ hơn về các nguồn gốc của sự không đồng nhất. Kết quả của việc bổ sung kẽm có thể được cải thiện bằng cách xác định những nhóm cần bổ sung kẽm.
Từ khóa
#kẽm #bổ sung kẽm #ngăn ngừa tiêu chảy #phân tích tổng hợp #thử nghiệm lâm sàng ngẫu nhiênTài liệu tham khảo
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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2334/11/122/prepub