芪冬颐心口服液联合磷酸肌酸钠对病毒性心肌炎的临床效果观察

Clinical efficacy of Qidongyixin oral solution combined with creatine phosphate sodium in the treatment of viral myocarditis

目的:研究芪冬颐心口服液联合磷酸肌酸钠对小儿病毒性心肌炎的临床效果。方法:将80例中医辨证为气阴两虚型病毒性心肌炎患儿采用随机数表法分为对照组(40例)和观察组(40例),对照组给予磷酸肌酸钠治疗,观察组在对照组基础上加用芪冬颐心口服液,2周为1个疗程,治疗1个疗程。比较两组临床疗效及心电图改善情况,检测T淋巴细胞水平(CD4+、CD8+、CD4+/CD8+)、炎性反应指标[白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)]、心肌酶谱[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]、心肌肌钙蛋白I(c Tn I)水平。结果:观察组患者治疗总有效率90.00%,明显高于对照组70.00%,心电图总有效率95.00%,明显高于对照组72.50%。观察组治疗后CD4+、CD4+/CD8+分别为(30.16±1.69、1.55±0.25)%,明显高于对照组(27.79±1.58、1.20±0.24)%,观察组CD8+(22.06±1.30)%,低于对照组(24.49±1.19)%。观察组治疗后IL-6、TNF-α、hs-CRP分别为(32.34±2.64)pg/ml、(9.52±3.74)ng/ml、(1.34±0.55)mg/L,均明显低于对照组(43.71±3.24)pg/ml、(14.43±3.94)ng/ml、(2.57±0.80)mg/L。观察组治疗后CK、CK-MB、LDH、c Tn I分别为(125.6±15.1)U/L、(19.15±5.26)U/L、(91.2±12.1)U/L、(0.15±0.06)μg/L,均明显低于对照组(147.7±19.3)U/L、(25.16±6.51)U/L、(125.5±13.5)U/L、(0.25±0.08)μg/L。结论:芪冬颐心口服液联合磷酸肌酸钠治疗儿童病毒性心肌炎可明显改善心肌功能,其机制可能为调节免疫功能、减轻炎症程度。

Objective： To investigate the clinical efficacy of Qidongyixin oral solution combined with creatine phosphate sodium in the treatment of viral myocarditis of children. Methods： 80 cases of children with viral myocarditis of Qi-Yin deficiency type were selected and randomly divided into the control group（ n = 40） and the observation group（ n = 40）. Patients in the control group were treated with creatine phosphate sodium,and those in the observation group were additionally treated with Qidongyixin oral solution,2 weeks as 1 course,for 1 course. The clinical efficacy and improvement of electrocardiogram were compared between two groups,and levels of T lymphocytes（ CD4＋,CD8＋,CD4＋/CD8＋）,inflammatory factors [interleukin 6（ IL-6）,tumor necrosis factor α（ TNF-α）,high sensitive C reactive protein（ hsCRP） ],myocardial enzymes [creatine kinase（ CK）,creatine kinase isoenzyme（ CK-MB）,lactate dehydrogenase（ LDH） ] and cardiac troponin I（ c Tn I） were detected. Results： The total effective rate and improvement rate of electrocardiogram in the observation group were90. 00% and 95. 00%,both better than those in the control group 70. 00% and 72. 50%（ P〈0. 05）. The CD4＋and CD4＋/CD8＋in the observation group after the treatment were（ 30. 16 ± 1. 69,1. 55 ± 0. 25） %,higher than those in the control group（ 27. 79 ± 1. 58,1. 20 ± 0.24） %（ P〈0. 05）. CD8＋in the observation group was（ 22. 06 ± 1. 30） %,lower than that in the control group（ 24. 49 ± 1. 19） %（ P〈0.05）. Levels of IL-6,TNF-α and hs-CRP in the observation group after the treatment were（ 32. 34 ± 2. 64） pg/ml,（ 9. 52 ± 3. 74） ng/ml,（ 1.34 ± 0. 55） mg/L,lower than those in the control group（ 43. 71 ± 3. 24） pg/ml,（ 14. 43 ± 3. 94） ng/ml,（ 2. 57 ± 0. 80） mg/L（ P〈0. 05）.CK,CK-MB,LDH and c Tn I levels in the observation group after treatment were（ 125. 6 ± 15. 1） U/L,（ 19. 15 ± 5. 26） U/L,（ 91. 2 ± 12. 1）U/L,（ 0. 15 ± 0. 06） μg/L,lower than those in the control group（ 147. 7 ± 19. 3） U/L,（ 25. 16 ± 6. 51） U/L,（ 125. 5 ± 13. 5） U/L,（ 0. 25 ±0. 08） μg/L（ P〈0. 05）. Conclusion： Qidongyixin oral solution combined with creatine phosphate sodium can obviously improve the myocardial function in children with viral myocarditis,and the mechanism may be regulation of immune function and decrease of inflammation.