磷酸肌酸对儿童柯萨奇病毒性心肌炎的保护作用

Protective Effect of Creatine Phosphate for Coxsachievirus Myocarditis in Children

目的观察磷酸肌酸(CP)对儿童柯萨奇病毒心肌炎(CVM)的保护作用,并初步探讨其可能机制。方法选取40例柯萨奇B组病毒感染心肌炎患儿为CVM组,并随机分为CP治疗组(CP组)和1,6-二磷酸果糖治疗组(果糖组),每组20例。同时,选择体检正常的健康儿童20例作为健康对照组。观察指标主要包括:血清柯萨奇病毒RNA和抗体IgM、心肌酶、高敏C反应蛋白(hs-CRP)、丙二醛(MDA)/超氧化物歧化酶(SOD)和细胞凋亡因子sFas/sFasL。MDA测定采用硫代巴比妥法,SOD测定采用化学比色法,sFas和sFasL测定采用双抗体夹心ABC-ELISA法;AST、LDH、α-羟丁酸脱氢酶(HBDH)、CK和CK-MB等心肌酶均由本院检验科采用全自动生化分析仪测定。应用SPSS13.0软件进行统计学分析。结果与健康对照组比较,CVM组血清柯萨奇病毒RNA和抗体IgM均显著增高,心肌酶、hs-CRP、MDA、sFas/sFasL显著升高(Pa<0.05,0.01),SOD明显降低(P<0.01);与治疗前比较,CP组及果糖组治疗后心肌酶(除果糖组CK外)、hs-CRP、MDA、sFas和sFasL各指标均显著下降(Pa<0.05,0.01);SOD显著升高(P<0.01);治疗后,CP组与果糖组各指标比较,差异无统计学意义(Pa>0.05)。结论CP对小儿CVM有较好的保护作用,其机制与清除自由基和抑制心肌细胞凋亡有关。

Objective To observe the protective effect of creatine phosphate（CP）for coxsachievirus myocarditis（CVM）in children,and explore its mechanisms.Methods Forty children with coxsachievirus B myocarditis were selected（CVM group）and were randomly divided into CP group（n=20）and fructose group（n=20）.Meanwhile,20 healthy children were selected as control group.Serum coxsachievirus RNA and antibody IgM,myocardial enzymes,high-sensitivity C reactive protein（hs-CRP）,malonaldehye（MDA）/superoxide dismutise（SOD）,apoptosis factor sFas/sFasL were detected.MDA level was determined by thibabituric acid method and SOD was determined by chemistry colorimetric method.ABC-ELISA method was used to measure sFas and sFasL.Aspartate aminotransferase（AST）,lactate dehydrogenase（LDH）,α-hydrooxybutyrate dehydrogenase（HBDH）,creatine kinase（CK）,creatine kinase isoenzyme MB（CK-MB）were detected with a completed automatic biochemistry analyzer in a clinical laboratory of Harbin Children＇s Hospital.All data were analyzed by SPSS 13.0 software.Results Coxsachievirus RNA and antibody IgM were positive in CVM group.Compared with control group,the level of serum myocardial enzymes,hs-CRP,MDA and sFas/sFasL were higher（Pa〈0.05,0.01）,and SOD was lower in CVM group（P〈0.01）.The level of serum myocardial enzymes（except CK in fructose group）,hs-CRP,MDA and sFas/sFasL in CP group and fructose group after treatment were decreased significantly than those before treatment（Pa〈0.05,0.01）,and SOD was increased significantly（P〈0.01）.There was no significant difference of every index after treatmeant between CP group and fructose group（Pa〉0.05）.Conclusions CP has protective effect on children with CVM,its mechanism may be related to scavenging oxygen free radical and inhibiting apoptosis.