参附养荣汤联合西医常规方法治疗Ⅰ～Ⅲ级小儿病毒性心肌炎临床研究

Shenfu Yangrong Decoction Combined with Routine Western Therapy for Treatment of Viral Myocarditis of Ⅰ– Ⅲ Grades in Children

目的观察参附养荣汤联合西医常规方法治疗Ⅰ~Ⅲ级小儿病毒性心肌炎(VMC)的临床效果。方法采用随机数字表法将100例VMC患儿分为观察组和对照组各50例。对照组予西医常规方法治疗,观察组在对照组基础上予参附养荣汤,每日1剂,每日2次,口服。连续治疗8周。观察2组临床疗效,比较2组治疗前后中医症状积分,血清白细胞介素(IL)-17、IL-27、核因子-κB(NF-κB)、肌钙蛋白Ⅰ(cTnⅠ)及心型游离脂肪酸结合蛋白(H-FABP)水平,监测不良反应。结果观察组总有效率为90%(45/50),对照组为74%(37/50),观察组显著高于对照组(χ~2=4.336,P=0.037)。与本组治疗前比较,2组治疗后中医主症、次症积分及总分显著下降(P<0.01)。2组治疗后比较,观察组中医主症、次症积分及总分显著低于对照组(P<0.05,P<0.01)。与本组治疗前比较,2组血清IL-17、NF-κB、cTnⅠ、H-FABP水平显著降低(P<0.01),血清IL-27水平显著升高(P<0.01)。2组治疗后比较,观察组血清IL-17、NF-κB、cTnⅠ、H-FABP水平显著低于对照组(P<0.01),血清IL-27水平显著高于对照组(P<0.01)。观察组不良反应发生率为12%(6/50),对照组为8%(4/50),2组比较差异无统计学意义(χ~2=0.368,P=0.544)。结论参附养荣汤联合西医常规方法治疗可有效减轻Ⅰ~Ⅲ级小儿病毒性心肌炎患儿症状,抑制炎症反应,减轻心肌损伤,具有较高的安全性。

Objective To observe the efficacy of Shenfu Yangrong Decoction combined with routine Western therapy in the treatment of viral myocarditis（VMC） of Ⅰ– Ⅲ grades in children. Methods Totally 100 cases of VMC children were selected and divided into observation group and control group according to random number table method, with 50 cases in both groups. The control group was treated with routine Western therapy, while the observation group was combined with Shenfu Yangrong Decoction based on the control group, one dosage a day, twice a day, orally. The TCM syndrome scores, the serum levels of interleukin（IL）-17, IL-27 and nuclear factor-κB（NF-κB）, the levevs of troponin Ⅰ（cTnⅠ） and cardiac free fatty acid binding protein（H-FABP） before and after treatment in both groups were compared, and the total incidence of adverse reactions during treatment was monitored. Results The total effective rate was 90%（45/50） in the observation group and 74%（37/50） in the control group. The observation group was significantly higher than the control group（χ~2=4.336, P=0.037）. Compared with before treatment, the scores of the main symptoms, the scores of the secondary symptoms, and the total scores of the two groups decreased significantly after treatment（P0.01）. Comparing the two groups after treatment, the scores of main symptoms, scores of secondary symptoms and total scores of the observation group were significantly lower than those of the control group（P0.05, P0.01）. Compared with before treatment, serum IL-17, NF-κB, cTnⅠ, H-FABP levels were significantly reduced（P0.01）, while serum IL-27 levels were significantly increased（P0.01） in both group. After treatment, the levels of serum IL-17, NF-κB, cTnⅠ, and H-FABP in the observation group were significantly lower than those in the control group（P0.01）, and serum IL-27 level in the observation group was significantly higher than in the control group（P0.01）. The adverse reaction rate was 12%（6/50） in the observation group and 8%（4/50） in the control group, without statistical significance between the two groups（χ~2=0.368, P=0.544）. Conclusion Shenfu Yangrong Decoction combined with routine Western therapy for the treatment of viral myocarditis children of Ⅰ– Ⅲ grades can effectively reduce the symptoms of patients, inhibit inflammation, reduce myocardial injury, with high safety.