锌缺乏症

对于大多数获得性锌缺乏症患者，可通过口服补充剂补足锌，其不良反应很少且价格低廉。除非根本病因得到解决（如乳糜泻或膳食中锌不足），否则应考虑终生服药。

补充剂配方包括硫酸锌、醋酸锌、葡萄糖酸锌、天冬氨酸锌和乳清酸锌。重要的是注意不同的锌配方的生物利用度差别巨大（如天冬氨酸锌或乳清酸锌比氧化锌更易吸收）。

应每 1-3 个月对锌缺乏症患者进行监测，确保补锌后症状消退且血清锌水平恢复正常。一旦锌水平恢复正常，应每 12 个月对仍具有持续性危险因素的患者进行监测，若症状复发则需提前进行。

应对长期、高剂量补充锌的患者铜水平进行监测，必要时可使用铜补充剂。

除了肠衰竭和/或长期接受全肠胃外营养的患者之外，基本没有必要使用肠胃外锌。[70]Sriram K, Lonchyna VA. Micronutrient supplementation in adult nutrition therapy: practical considerations. JPEN J Parenter Enteral Nutr. 2009;33:548-562.http://www.ncbi.nlm.nih.gov/pubmed/19454751?tool=bestpractice.com

对于多数获得性锌缺乏症患者，致力于改善诱发疾病是恰当的。

导致患者处于锌缺乏症风险的疾病包括：吸收不良症、慢性肠胃病（腹部疾病或克罗恩氏病）[1]Singhal N, Alam S, Sherwani R, et al. Serum zinc levels in celiac disease. Indian Pediatr. 2008;45:319-321.http://www.ncbi.nlm.nih.gov/pubmed/18451454?tool=bestpractice.com[4]Goh J, O'Morain CA. Review article: nutrition and adult inflammatory bowel disease. Aliment Pharmacol Ther. 2003;17:307-320.http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2036.2003.01482.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12562443?tool=bestpractice.com[5]Ojuawo A, Keith L. The serum concentrations of zinc, copper and selenium in children with inflammatory bowel disease. Cent Afr J Med. 2002;48:116-119.http://www.ncbi.nlm.nih.gov/pubmed/14562534?tool=bestpractice.com、肝病、[6]Narkewicz MR, Krebs N, Karrer F, et al. Correction of hypozincemia following liver transplantation in children is associated with reduced urinary zinc loss. Hepatology. 1999;29:830-833.http://www.ncbi.nlm.nih.gov/pubmed/10051486?tool=bestpractice.com[7]Stamoulis I, Kouraklis G, Theocharis S. Zinc and the liver: an active interaction. Dig Dis Sci. 2007;52:1595-1612.http://www.ncbi.nlm.nih.gov/pubmed/17415640?tool=bestpractice.com肾脏疾病、[17]Perrone L, Gialanella G, Giordano V, et al. Impaired zinc metabolic status in children affected by idiopathic nephrotic syndrome. Eur J Pediatr. 1990;149:438-440.http://www.ncbi.nlm.nih.gov/pubmed/2332016?tool=bestpractice.com[12]Kalantar-Zadeh K, Kopple JD. Trace elements and vitamins in maintenance dialysis patients. Adv Ren Replace Ther. 2003;10:170-182.http://www.ncbi.nlm.nih.gov/pubmed/14708071?tool=bestpractice.com[13]Mahajan SK. Zinc in kidney disease. J Am Coll Nutr. 1989;8:296-304.http://www.ncbi.nlm.nih.gov/pubmed/2674256?tool=bestpractice.com糖尿病、[8]Chausmer AB. Zinc, insulin and diabetes. J Am Coll Nutr. 1998;17:109-115.http://www.ncbi.nlm.nih.gov/pubmed/9550453?tool=bestpractice.com[9]Zheng Y, Li XK, Wang Y, et al. The role of zinc, copper and iron in the pathogenesis of diabetes and diabetic complications: therapeutic effects by chelators. Hemoglobin. 2008;32:135-145.http://www.ncbi.nlm.nih.gov/pubmed/18274991?tool=bestpractice.com镰状细胞病、[14]Prasad AS. Zinc deficiency in patients with sickle cell disease. Am J Clin Nutr. 2002;75:181-182.http://ajcn.nutrition.org/content/75/2/181.fullhttp://www.ncbi.nlm.nih.gov/pubmed/11815307?tool=bestpractice.com[11]Bao B, Prasad AS, Beck FW, et al. Zinc supplementation decreases oxidative stress, incidence of infection, and generation of inflammatory cytokines in sickle cell disease patients. Transl Res. 2008;152:67-80.http://www.ncbi.nlm.nih.gov/pubmed/18674741?tool=bestpractice.com、HIV 感染。[15]Koch J, Neal EA, Schlott MJ, et al. Zinc levels and infections in hospitalized patients with AIDS. Nutrition. 1996;12:515-518.http://www.ncbi.nlm.nih.gov/pubmed/8878145?tool=bestpractice.com[16]Kupka R, Fawzi W. Zinc nutrition and HIV infection. Nutr Rev. 2002;60:69-79.http://www.ncbi.nlm.nih.gov/pubmed/11908743?tool=bestpractice.com同理，使用某些药物（如氢氯噻嗪、青霉胺、乙胺丁醇和某些抗生素）进行慢性治疗的患者、酗酒者、[18]Kang YJ, Zhou Z. Zinc prevention and treatment of alcoholic liver disease. Mol Aspects Med. 2005;26:391-404.http://www.ncbi.nlm.nih.gov/pubmed/16099027?tool=bestpractice.com[19]Rico H. Alcohol and bone disease. Alcohol Alcohol. 1990;25:345-352.http://www.ncbi.nlm.nih.gov/pubmed/2222569?tool=bestpractice.com素食者、严格素食者和营养不良的婴儿[20]Hambidge KM, Krebs NF. Zinc deficiency: a special challenge. J Nutr. 2007;137:1101-1105.http://jn.nutrition.org/content/137/4/1101.fullhttp://www.ncbi.nlm.nih.gov/pubmed/17374687?tool=bestpractice.com更易患锌缺乏症。老年人患锌缺乏症会导致其感染易感性和骨质疏松症发病率增加。[21]Haase H, Mocchegiani E, Rink L. Correlation between zinc status and immune function in the elderly. Biogerontology. 2006;7:421-428.http://www.ncbi.nlm.nih.gov/pubmed/16953331?tool=bestpractice.com[10]Atik OS, Uslu MM, Eksioglu F, et al. Etiology of senile osteoporosis: a hypothesis. Clin Orthop Relat Res. 2006;443:25-27.http://www.ncbi.nlm.nih.gov/pubmed/16462422?tool=bestpractice.com一项研究表明补充锌可以降低感染的危险。[26]Prasad AS, Beck FW, Bao B, et al. Zinc supplementation decreases incidence of infections in the elderly: effect of zinc on generation of cytokines and oxidative stress. Am J Clin Nutr. 2007;85:837-844.http://ajcn.nutrition.org/content/85/3/837.fullhttp://www.ncbi.nlm.nih.gov/pubmed/17344507?tool=bestpractice.com

需进行对症处理以减轻肠胃症状（包括厌食、舌炎、腹痛和腹泻）。

针对经选择患者组全部患者的治疗推荐

应对长期、高剂量补充锌的患者进行监测，查看是否导致铜缺乏症。若检测出铜缺乏症，低剂量铜补充剂通常有不错的疗效。

对于肠病性肢端皮炎，患者需要终生服用补充剂。若长期补充锌，则可能需要依照连续的血清锌检测来制定个体化剂量。应检测铜水平，必要时给予补充剂。

治疗的中断会导致症状和体征的复发。

由于锌缺乏症的皮肤表现与酶功能缺陷相关，局部治疗通常无效。

针对经选择患者组全部患者的治疗推荐

由于在吸收方面锌与铜是竞争关系，应定期对铜水平进行评估，有时需要同时补充铜补充剂。