左卡尼汀联合美托洛尔治疗儿童扩张型心肌病的效果及对血清s ST2、TGF-β及心功能的影响

Effectiveness of levocanidine in combination with metoprolol in the treatment of dilated cardiomyopathy in children and the effect on serum s ST2,TGF-β and cardiac function

目的:分析左卡尼汀联合美托洛尔治疗儿童扩张型心肌病的效果及对血清可溶性ST2蛋白(sST2)、转化生长因子-β(TGF-β)及心功能相关指标的影响。方法:选择2019年1月—2022年11月在玉林市红十字会医院治疗的22例及四川大学华西第二医院收治的70例扩张型心肌病患儿作为研究对象,采用随机数表法分为试验组(n=47)和对照组(n=45)。对照组给予美托洛尔治疗,试验组应用美托洛尔、左卡尼汀治疗。比较两组临床疗效、生命体征、血清sST2、TGF-β、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)变化情况、不良反应发生情况。结果:治疗4周后,试验组治疗总有效率为89.36%高于对照组的71.11%,试验组收缩压、舒张压分别为(114.87±7.16)mmHg和(86.12±5.02)mmHg,高于对照组的(110.72±8.04)mmHg和(83.46±5.35)mmHg,心率为(100.34±9.24)次/分,低于对照组的(105.59±10.63)次/分,试验组的血清sST2、TGF-β分别为(0.07±0.01)ng/mL和(131.12±10.07)ng/L,低于对照组的(0.16±0.04)ng/mL和(185.46±7.41)ng/L;试验组的LVESD、LVEDD分别为(30.71±7.12)mm和(63.28±9.18)mm,低于对照组的(36.89±6.56)mm和(70.79±10.56)mm,LVEF为(49.63±3.35)%,高于对照组的(43.29±2.51)%;试验组的6 min步行距离为(399.64±59.97)m,高于对照组的(309.64±48.79)m,NT-proBNP为(2411.08±1108.15)ng/L,低于对照组的(3451.14±1567.59)ng/L。试验组与对照组用药不良反应发生率无明显差异。结论:在儿童扩张型心肌病患者中应用左卡尼汀联合美托洛尔治疗效果显著,可有效改善患者生命体征、血清s ST2、TGF-β及心功能水平,且不增加不良反应。

Objective:To analyze the effect of levocarnitine combined with metoprolol in the treatment of children with dilated cardiomyopathy,as well as the influence on serum soluble ST2 protein(s ST2),transforming growth factor(TGF)and cardiac function-related indicators.Methods From January 2019 to November 2022,22 children with Dilated cardiomyopathy admitted to Yulin Red Cross Society Hospital and 70 children with Dilated cardiomyopathy admitted to West China Second Hospital of Sichuan University were selected as research subjects,and divided into experimental group(n=47)and control group(n=45)by the random number table approach.Metoprolol was administered to the control group,while levocarnitine and metoprolol were administered to the experimental group.The clinical efficacy,vital signs,serum s ST2,TGF-β,left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),adverse reactions were compared between the two groups.Results After 4 weeks of treatment,the total effective rate of treatment in experimental group was higher than that in control group(89.36%vs 71.11%).After treatment,the systolic blood pressure and diastolic blood pressure with(114.87±7.16)mmHg and(86.12±5.02)mmHg in experimental group were higher than(110.72±8.04)mmHg and(83.46±5.35)mmHg in control group while the heart rate with(100.34±9.24)beats/min was lower than(105.59±10.63)beats/min in control group.The levels of serum s ST2 and TGF-β in experimental group after treatment were(0.07±0.01)ng/mL and(131.12±10.07)ng/L,which were lower than(0.16±0.04)ng/mL and(185.46±7.41)ng/L in control group.After treatment,the LVESD and LVEDD with(30.71±7.12)mm and(63.28±9.18)mm in experimental group were lower than(36.89±6.56)mm and(70.79±10.56)mm in control group while the LVEF with(49.63±3.35)%was higher compared with(43.29±2.51)%in control group.After treatment,the 6 minutes walking distance with(399.64±59.97)m in experimental group was longer than(309.64±48.79)m in control group,and NT-proBNP with(2411.08±1108.15)ng/L was lower than(3451.14±1567.59)ng/L in control group.There was no significant difference in the incidence of adverse drug reactions.Conclusion Levocarnitine combined with metoprolol has a significant effect on children with dilated cardiomyopathy,and it can effectively improve the vital signs,serum s ST2,TGF-β and cardiac function,without increasing adverse reactions.