磷酸肌酸钠联合维生素C治疗儿童病毒性心肌炎的系统评价

Systematic Review of Sodium Creatine Phosphate Combined with Vitamin C in the Treatment of Pediatric Viral Myocarditis

目的:系统评价磷酸肌酸钠联合维生素C治疗儿童病毒性心肌炎的有效性,进一步为临床治疗儿童病毒性心肌炎提供新的治疗策略及应用依据。方法:检索中国知网、中国生物医学文献数据库、万方数据库、维普数据库及PubMed等数据库,纳入公开发表的磷酸肌酸钠联合维生素C治疗儿童病毒性心肌炎的随机对照试验(对照组患儿采用常规治疗,观察组患儿采用磷酸肌酸钠联合维生素C治疗),运用Rev Man 5. 3软件对符合纳入标准的文献进行荟萃分析(Meta分析)。结果:最终纳入文献17篇,共涉及1 592例患儿。Meta分析结果显示,观察组患儿的总有效率明显高于对照组,差异有统计学意义(OR=4. 57,95%CI=3. 10~6. 73,P<0. 000 01);观察组患儿血清肌酸激酶(MD=-38. 38,95%CI=-65. 76^-10. 99,P=0. 006)、乳酸脱氢酶(MD=-42. 76,95%CI=-78. 83^-6. 68,P=0. 02)水平明显低于对照组,差异有统计学意义;观察组患儿心肌肌钙蛋白I水平低于对照组,但差异无统计学意义(MD=-0. 15,95%CI=-0. 17^-0. 13,P=0. 30);治疗期间,两组患儿均未发生不良反应。结论:基于目前的研究,磷酸肌酸钠联合维生素C治疗儿童病毒性心肌炎的疗效较常规治疗更理想,这为临床采用磷酸肌酸钠联合维生素C治疗儿童病毒性心肌炎提供了证据。

OBJECTIVE: To systematically evaluate the efficacy of sodium creatine phosphate combined with vitamin C in the treatment of pediatric viral myocarditis,so as to provide new therapeutic strategies and application basis for clinical treatment of pediatric viral myocarditis. METHODS: CNKI,CBM,Wanfang database,VIP database and PubMed were retrieved to collect the randomized controlled trial of sodium creatine phosphate combined with vitamin C in the treatment of pediatric viral myocarditis( the control group received conventional treatment,while the observation group was treated with sodium creatine phosphate combined with vitamin C). Literature that met the inclusion criteria was analyzed by using RevMan 5. 3 software( Meta-analysis). RESULTS: Totally 17 literature were collected,including 1 592 patients. Meta analysis results showed that the total effective rate in the observation group was significantly higher than that in the control group,and the difference was statistically significant( OR = 4. 57,95%CI = 3. 10-6. 73,P<0. 000 01). Serum creatine kinase( MD =-38. 38,95%CI =-65. 76--10. 99,P = 0. 006) and lactate dehydrogenase( MD =-42. 76,95% CI =-78. 83--6. 68,P = 0. 02) were significantly lower in the observation group than those in the control group,with statistically significant differences. The cardiac troponin I level in the observation group was lower than that in the control group,yet the difference was not statistically significant( MD =-0. 15,95%CI =-0. 17--0. 13,P = 0. 30). During the treatment,no adverse drug reactions were observed in both groups. CONCLUSIONS: Based on current studies,creatine phosphate combined with vitamin C is more effective than conventional treatment in the treatment of viral myocarditis in children,which provides evidence for the clinical use of creatine phosphate combined with vitamin C in the treatment of viral myocarditis in children.