左卡尼汀对重症手足口病患儿血清脑钠肽、氨基末端前脑钠肽水平及心功能的影响

Effects of L-carnitine on serum levels of brain natriuretic peptide and N-terminal pro-brain natriuretic peptide and cardiac function in children with severe hand-footmouth disease

目的观察左卡尼汀辅助治疗对心功能异常的重症手足口病患儿血清脑钠肽(BNP)、氨基末端前脑钠肽(NT-proBNP)异常及心脏功能的影响。方法选取重症手足口病患儿120例,按随机数字表法分为常规治疗组(常规组)和左卡尼汀治疗组(左卡组),每组60例。另选取30名健康体检儿童作为健康对照组。两组患儿均给予退热、抗病毒等治疗作为基础治疗,左卡组在基础治疗基础上给予左卡尼汀辅助治疗。观察两组患儿临床疗效及转归;检测对照组儿童及两组患儿治疗前后不同时间点血清BNP、NT-proBNP水平,以及心率(HR)、左室射血分数(LVEF)、射血缩短分数(FS)、心脏指数(CI)等心功能指标。结果治疗前,两组患儿血清BNP、NT-proBNP水平及HR均明显高于对照组,而LVEF、FS、CI均明显低于对照组(P<0.05)。治疗后,左卡组临床有效率明显高于常规组(P<0.05)。治疗3d后,左卡组血清BNP和NT-proBNP水平均明显低于治疗前及常规组(P<0.05),与对照组相比,差异无统计学意义(P>0.05);左卡组LVEF、FS、CI水平均低于治疗前及常规组(P<0.05),略低于对照组,但差异无统计学意义(P>0.05)。治疗5d后,左卡组血清BNP及NT-proBNP水平,以及LVEF、FS、CI与常规组相比,差异均无统计学意义(P>0.05)。左卡组心率恢复正常时间较常规组明显缩短(P<0.05)。结论左卡尼汀辅助治疗重症手足口病能够早期有效降低血清BNP、NT-proBNP水平,改善异常的心脏功能,提高临床疗效和改善临床转归。

Objective To observe the effects of L-carnitine treatment on serum levels of brain natriuretic peptide（BNP） and N-terminal pro-BNP（NT-proBNP） and cardiac function in children with heart dysfunction and severe handfoot-mouth disease（HFMD）. Methods A total of 120 children with severe HFMD were enrolled and randomly and equally divided into routine treatment group and L-carnitine treatment group. Thirty healthy children served as the control group. HFMD patients were given anti-fever and antiviral treatment as the basic treatment, while the patients in the L-carnitine treatment group were given L-carnitine as an adjuvant treatment to the basic treatment. Treatment outcomes were observed in the two groups. For all the subjects, serum levels of BNP and NT-proBNP and cardiac function parameters including left ventricular ejection fraction（LVEF）, fractional shortening（FS）, and cardiac index（CI） were measured at different time points before and after treatment. Results Before treatment, HFMD patients had significantly higher serum levels of BNP and NT-proBNP and heart rate but significantly lower LVEF, FS, and CI compared with the control group（P〈0.05）. After treatment, the L-carnitine treatment group had a significantly higher response rate than the routine treatment group（P〈0.05）. After 3 days of treatment, the serum levels of BNP and NTproBNP, LVEF, FS, and CI were significantly reduced in the L-carnitine group（P〈0.05）; the L-carnitine group had significantly lower serum levels of BNP and NT-proBNP, LVEF, FS, and CI than the routine treatment group（P〈0.05）; there were no significant differences in the serum levels of BNP and NT-proB NP, LVEF, FS, or CI between the L-carnitine treatment and control groups（P〉0.05）. After 5 days of treatment, there were no significant differences in the serum levels of BNP and NT-proB NP, LVEF, FS, or CI between the L-carnitine treatment and routine treatment groups（P〉0.05）. Heart rate recovery was significantly slower in the routine treatment group than in the L-carnitine treatment group（P〈0.05）. Conclusions As an adjuvant therapy for severe HFMD, L-carnitine treatment has satisfactory short-term efficacy in reducing the serum levels of BNP and NT-proBNP and improving cardiac function, thus improving clinical outcomes.