香丹注射液联合左卡尼汀治疗急性病毒性心肌炎的临床研究

Clinical study on Xiangdan Injection combined with levocarnitine in treatment of acute viral myocarditis

目的探讨香丹注射液联合左卡尼汀治疗急性病毒性心肌炎的临床效果。方法选取2014年2月—2017年2月上海市静安区闸北中心医院收治的急性病毒性心肌炎患者80例,随机分为对照组(40例)和治疗组(40例)。对照组静脉滴注左卡尼汀注射液,100 mg/kg加入5%葡萄糖溶液100 mL,1次/d。治疗组在对照组基础上静脉滴注香丹注射液,0.5 mL/kg加入5%葡萄糖溶液100 mL,最大剂量15 mL/d,1次/d。两组均连续治疗14 d。观察两组患者临床疗效,同时比较治疗前后两组患者症状改善时间、心肌酶谱、心功能指标、氧化应激指标、免疫球蛋白和淋巴细胞水平。结果治疗后,对照组和治疗组临床有效率分别为77.5%、95.0%,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组患者胸闷、头晕、肢冷、烦躁等症状改善时间比对照组显著缩短(P<0.05)。治疗后,两组血清天门冬氨酸氨基转移酶(AST)、磷酸肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)水平均显著下降(P<0.05),左室射血分数(LVEF)、每搏输出量(SV)显著升高(P<0.05),且治疗后治疗组心肌酶谱和心功能指标改善明显优于对照组(P<0.05)。治疗后,两组血清超氧化物歧化酶(SOD)、谷胱甘肽(GSH)水平均显著升高(P<0.05),血清丙二醛(MDA)水平均显著降低(P<0.05),且治疗后治疗组比对照组改善更明显(P<0.05)。治疗后,两组血清IgA、IgG水平均显著上升(P<0.05),外周血Th17细胞百分率、Th17/Treg比率均显著减小(P<0.05),且治疗后治疗组比对照组改善更明显(P<0.05)。结论香丹注射液联合左卡尼汀治疗急性病毒性心肌炎更能有效缓解患者症状,改善心功能,调控机体氧化应激状态,增强免疫功能。

Objective To investigate the clinical effect of Xiangdan Injection combined with levocarnitine in treatment of acute viral myocarditis. Methods Patients（80 cases） with acute viral myocarditis in Zhabei Central Hospital of Shanghai Jingan District from February 2014 to February 2017 were randomly divided into control（40 cases） and treatment（40 cases） groups. Patients in the control group were iv administered with Levocarnitine Injection, 100 mg/kg added into 5% glucose solution 100 mL, once daily. Patients in the treatment group were iv administered with Xiangdan Injection on the basis of the control group, 0.5 mL/kg added into 5% glucose solution 100 mL, and the maximum dose was 15 mL/d, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and the symptom improvement time, the myocardial enzymogram, the cardiac function indexes, the oxidative stress indexes, the immunoglobulin and lymphocyte levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups was 77.5% and 95.0%, respectively, and there were differences between two groups（P〈0.05）. After treatment, the improvement times of chest distress, dizzy, limb cold, and irritability in the treatment group were significantly shorter than those in the control group（P〈0.05）. After treatment, the AST, CK, CK-MB, and LDH levels in two groups were significantly decreased（P〈0.05）, but LVEF and SV levels were significantly increased（P〈0.05）, and the myocardial enzymogram and cardiac function indexes in the treatment group were significantly better than those in the control group（P〈0.05）. After treatment, the serum SOD and GSH levels in two groups were significantly increased（P〈0.05）, but serum MDA levels were significantly decreased（P〈0.05）, and these indexes levels in the treatment group were significantly better than those in the control group（P〈0.05）. After treatment, the serum IgA and IgG levels in two groups were significantly increased（P〈0.05）, but the percentage of Th17 cells in peripheral blood and Th17/Treg ratio were significantly decreased（P〈0.05）, and these indexes in the treatment group were significantly better than those in the control group（P〈0.05）. Conclusion Xiangdan Injection combined with levocarnitine in treatment of acute viral myocarditis can effectively alleviate symptoms, improve cardiac function, regulate the oxidative stress state, and enhance immune function.