左卡尼汀联合环磷腺苷对病毒性心肌炎患者的疗效及对IFN-γ和IL-4水平的影响

Therapeutic effect of L-carnitine combined cyclic adenosine monophosphate and its influence on serum levels of IFN-γ and IL-4 in patients with viral myocarditis

目的:观察左卡尼汀联合环磷腺苷对病毒性心肌炎(VMC)患者的疗效及对血清干扰素(IFN)-γ和白介素(IL)-4水平的影响。方法: 2017年到2018年于我院治疗的VMC患者132例被随机均分为左卡尼汀组(在常规治疗基础上接受左卡尼汀治疗)和联合治疗组(在左卡尼汀组基础上接受环磷腺苷治疗),两组均治疗2周。观察比较两组治疗前、后外周血血清IFN-γ、IL-4、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)水平,临床疗效以及药物不良反应。结果:与治疗前比较,治疗2周后两组血清IL-4水平均显著升高,血清IFN-γ、cTnT和CK-MB水平均显著降低, P 均=0.001;与左卡尼汀组比较,联合治疗组血清IL-4水平[(47.43±9.17)ng/ml比(55.38±10.23)ng/ml]升高更显著,血清IFN-γ[(65.22±11.82)ng/ml比(52.18±10.06)ng/ml]、cTnT[(0.37±0.09)ng/ml比(0.18±0.03)ng/ml]和CK-MB[(28.56±5.34)U/L比(16.22±3.47)U/L]水平降低更显著, P 均=0.001。联合治疗组治疗总有效率显著高于左卡尼汀组(92.4%比80.3%), P =0.042。两组药物不良反应率无显著差异, P =0.784。结论:左卡尼汀联合环磷腺苷可以显著降低病毒性心肌炎患者外周血IFN-γ水平和升高IL-4水平,调节Th1/Th2失衡,疗效显著,安全性好。

Objective: To observe therapeutic effect of L-carnitine combined cyclic adenosine monophosphate and its influence on serum levels of IFN-γ and IL-4 in patients with viral myocarditis. Methods: A total of 132 VMC patients treated in our hospital from 2017 to 2018 were randomly and equally divided into L-carnitine group and combined treatment group (received cAMP based on L-carnitine group),both groups were treated for two weeks. Peripheral serum levels of IFN-γ,IL-4,cardiac troponin T (cTnT) and creatine kinase isoenzyme MB (CK-MB) before and two weeks after treatment,therapeutic effect and incidence of adverse drug reactions were observed and compared between two groups. Results: Compared with before treatment,there was significant rise in serum IL-4 level,and significant reductions in serum levels of IFN-γ,cTnT and CK-MB in two groups after two-week treatment, P =0.001 all;compared with L-carnitine group,there was significant rise in serum IL-4 level [(47.43±9.17) ng/ml vs.(55.38±10.23)ng/ml],and significant reductions in serum levels of IFN-γ[(65.22±11.82)ng/ml vs.(52.18±10.06)ng/ml],cTnT[(0.37±0.09)ng/ml vs.(0.18±0.03)ng/ml] and CK-MB [(28.56± 5.34) U/L vs.(16.22±3.47)U/L] in combined treatment group, P =0.001 all. Total effective rate of combined treatment group was significantly higher than that of L-carnitine group (92.4% vs. 80.3%), P =0.042. There was no significant difference in incidence rate of adverse drug reactions between two groups, P =0.784. Conclusion: L-carnitine combined cAMP can significantly reduce peripheral serum IFN-γ level and increase IL-4 level,regulate Th1/Th2 imbalance with significant therapeutic effect in VMC patients. And its safety is good.