大剂量VitC联合免疫球蛋白治疗小儿病毒性心肌炎的临床价值

Clinical value of high-dose VitC +immunoglobulin for the treatment of viral myocarditis in children

目的:研究大剂量VitC+免疫球蛋白治疗小儿病毒性心肌炎的临床价值。方法:选择2014年5月~2017年3月期间在我院诊断为病毒性心肌炎的患儿作为研究对象,采用随机数表法分为两组,观察组患儿接受大剂量VitC+免疫球蛋白联合常规对症支持治疗,对照组接受常规对症支持治疗。治疗前及治疗后1周、2周时,测定血清中心肌损伤指标、心肌重塑指标及炎症反应指标的含量。结果:治疗后1周、2周时,两组患者血清中肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、丙二醛(MDA)、脑利钠肽(BNP)、I型前胶原氨基端肽(PINP)、I型胶原吡啶交联终肽(ICTP)、基质金属蛋白酶(MMP)2、MMP9、转化生长因子β1(TGFβ1)、肿瘤坏死因子(TNF)-α、细胞间黏附分子(ICAM-1)、MIP-1α、白介素(IL)-17的含量均显著低于治疗前(P<0.05),且观察组患儿血清中CK-MB、cTnI、MDA、BNP、PINP、ICTP、MMP2、MMP9、TGFβ1、TNF-α、ICAM-1、MIP-1α、IL-17的含量低于对照组(P<0.05)。结论:大剂量VitC+免疫球蛋白治疗小儿病毒性心肌炎能够减轻心肌损伤、抑制心肌重塑及炎症反应。

Objective:To study the clinical value of high-dose VitC +immunoglobulin for the treatment of viral myocarditis in children.Methods:Children who were diagnosed with viral myocarditis in the hospital between May 2014 and March2017 were selected as the research subjects and divided into two groups by random number table,observation group received high-dose VitC +immunoglobulin combined with conventional symptomatic and supportive treatment and control group received conventional symptomatic and supportive treatment.The serum levels of myocardial injury indexes,myocardial remodeling indexes and inflammatory response indexes were measured before treatment as well as at 1 week and 2 weeks after treatment.Results:1 week and 2 weeks after treatment,serum CK-MB,cTnI,MDA,BNP,PINP,ICTP,MMP2,MMP9,TGFβ1,TNF-α,ICAM-1,MIP-1αand IL-17 levels of both groups of patients were significantly lower than those before treatment,and serum CK-MB,cTnI,MDA,BNP,PINP,ICTP,MMP2,MMP9,TGFβ1,TNF-α,ICAM-1,MIP-1αand IL-17 levels of observation group were lower than those of control group.Conclusion:High-dose VitC +immunoglobulin can reduce the myocardial damage and inhibit the myocardial remodeling and inflammatory response in children with viral myocarditis.