环磷腺苷葡胺治疗小儿病毒性心肌炎效果及对心脏功能康复情况的影响

Effect of cyclic adenosine glucosamine on viral myocarditis in children and its influence on the recovery of cardiac function

目的观察环磷腺苷葡胺治疗小儿病毒性心肌炎的效果及对心脏功能康复情况的影响。方法本文为前瞻性研究,病例纳入时间为2021年1月至2022年12月,研究对象为南阳医学高等专科学校第一附属医院119例病毒性心肌炎患儿,通过随机数字表法对入组患儿进行分组,分为观察组(60例)和对照组(59例)。对照组中男34例,女25例,年龄(9.02±2.17)岁,予以常规治疗;观察组中男32例,女28例,年龄(9.25±2.23)岁,采用环磷腺苷葡胺配合常规治疗。比较两组患儿治疗前后的免疫功能、心肌损伤标志物及心功能指标改善情况,统计并对比两组患儿治疗后的药物相关不良反应发生情况。采用独立样本t检验、配对t检验、χ^(2)检验。结果治疗前,两组患儿的免疫功能、心肌损伤标志物、心功能指标差异均无统计学意义(均P>0.05)。治疗后,观察组的T淋巴细胞分化抗原3(CD3)为(65.77±10.26)%,CD4为(43.39±10.11)%,CD8为(30.15±5.28)%,均高于对照组的(58.24±10.16)%、(37.88±10.21)%、(27.66±5.19)%,差异均有统计学意义(t=4.022、2.958、2.594,均P<0.05)。治疗后,观察组的肌酸激酶为(42.33±10.15)U/L,肌酸激酶同工酶为(43.15±10.61)U/L,乳酸脱氢酶为(85.22±10.17)U/L,均低于对照组的(49.25±10.27)U/L、(50.44±10.22)U/L、(91.22±10.46)U/L,差异均有统计学意义(t=3.697、3.816、3.173,均P<0.05)。治疗后,观察组的心脏指数为(3.37±0.88)L/(min·m^(2)),心室短轴缩短率为(38.25±8.41)%,射血分数为(66.78±10.62)%,均高于对照组的(2.72±0.65)L/(min·m^(2))、(33.41±8.26)%、(60.32±10.27)%,差异均有统计学意义(t=4.577、3.167、3.372,均P<0.05)。治疗后,观察组的药物相关不良反应总发生率为8.33%(5/60),略高于对照组的6.78%(4/59),差异无统计学意义(χ^(2)=0.172,P=0.678)。结论环磷腺苷葡胺结合常规治疗能有效改善病毒性心肌炎患儿的免疫功能并缓解心肌损伤,在有效促进患儿心脏功能康复的同时,并未明显增强不良反应发生风险。

Objective To observe the effect of cyclic adenosine glucosamine on viral myocarditis in children and its influence on the recovery of cardiac function.Methods This article was a prospective study.A total of 119 children with viral myocarditis in the First Affiliated Hospital of Nanyang Medical College from January 2021 to December 2022 were divided into an observation group(60 cases)and a control group(59 cases)by the random number table method.In the control group,34 males and 25 females,aged(9.02±2.17)years,were given routine treatment;in the observation group,32 males and 28 females,aged(9.25±2.23)years,were treated with cyclic adenosine glucosamine combined with routine treatment.The improvement of immune function,myocardial injury markers,and cardiac function indexes before and after treatment were compared between the two groups,and the occurrence of drug-related adverse reactions after treatment was statistically analyzed and compared between the two groups.Independent sample t test,paired t test,andχ^(2) test were used.Results Before treatment,there were no statistically significant differences in the immune function,myocardial injury markers,and cardiac function indicators between the two groups(all P>0.05).After treatment,the CD3,CD4,and CD8 in the observation group were(65.77±10.26)%,(43.39±10.11)%,and(30.15±5.28)%,which were higher than those in the control group[(58.24±10.16)%,(37.88±10.21)%and(27.66±5.19)%],with statistically significant differences(t=4.022,2.958,and 2.594;all P<0.05).After treatment,the levels of creatine kinase,creatine kinase isoenzyme,and lactate dehydrogenase in the observation group were(42.33±10.15)U/L,(43.15±10.61)U/L,and(85.22±10.17)U/L,respectively,which were lower than those in the control group[(49.25±10.27)U/L,(50.44±10.22)U/L,and(91.22±10.46)U/L],with statistically significant differences(t=3.697,3.816,and 3.173;all P<0.05).After treatment,the cardiac index of the observation group was(3.37±0.88)L/(min·m^(2)),the ventricular short axis shortening fraction was(38.25±8.41)%,and the ejection fraction was(66.78±10.62)%,which were higher than those in the control group[(2.72±0.65)L/(min·m^(2)),(33.41±8.26)%,and(60.32±10.27)%],with statistically significant differences(t=4.577,3.167,and 3.372;all P<0.05).After treatment,the total incidence of drug-related adverse reactions in the observation group was 8.33%(5/60),which was slightly higher than that in the control group[6.78%(4/59)],without statistically significant difference(χ^(2)=0.172,P=0.678).Conclusion The combination of cyclic adenosine glucosamine and routine treatment can effectively improve the immune function and alleviate the myocardial injury in children with viral myocarditis,and has a positive effect on promoting the recovery of cardiac function in children but does not significantly increase the risk of adverse reactions.