人巨细胞病毒感染性心肌炎干预措施的研究

Study on the Intervening Measures in Children with Infective Myocarditis of Human Cytomegalovirus (HCMV)

【目的】探讨人巨细胞病毒 (HCMV)感染后小儿心肌炎的病因治疗干预措施及临床意义。【方法】对 4 0例HCMV DNA阳性心肌炎患儿随机分为两个治疗组 ,同时采用综合治疗基础上给予抗病毒治疗 :更昔洛韦组 (Ⅰ组 ) 30例 ,病毒唑 (Ⅱ组 ) 1 0例。治疗后分别治疗前与治疗后对HCMV DNA拷贝量比较 ;对CK MB、CTnT、心功能指标进行治疗前后对照。【结果】HCMV DNA拷贝量的下降速度治疗前后比较 ,Ⅰ组明显优于Ⅱ组 ,差异有显著性 (P <0 .0 1 )。CK MB治疗前后的变化 ,2周后Ⅰ组优于Ⅱ组 (P <0 .0 5 ) ,治疗 4周后两组无变化。心功能指标显示 ,经 2周治疗后收缩功能指标恢复情况 ,Ⅰ组明显好于Ⅱ组 (P <0 .0 1 ) ;心室充盈分数两组无差异 (P >0 .0 5 )。【结论】HCMV感染小儿心肌炎的抗病毒治疗十分重要 ,是目前病因干预的主要措施之一 ;更昔洛韦对HCMV感染所导致的心肌炎有肯定疗效。

To explore the cause, therapeutic intervening measures and clinical significance of children myocarditis after infection with human cytomegalovirus (HCMV).Forty children with myocarditis of HCMV DNA positive were subjected to antiviral therapy on the basis of simultaneous comprehensive treatment. They were randomly divided into 2 groups: Group Ⅰ, 30 cases treated with ganciclovir; Group Ⅱ, 10 cases treated with ribavirin. Their copy numbers of HCMV DNA, serum creatine kinase MB(CK MB) activities and cardiac troponin Ⅰ (CTnI) levels as well as indexes of cardiac function before and after treatment were compared.The declining speed of HCMV DNA copy numbers in Group Ⅰ was obviously better than that of Group Ⅱ(P<0.01), when a comparison between the results before and after treatment was made. As for the changes of CK MB activity, the improvement in Group Ⅰ during 2 wks after treatment was more prominent than that in Group Ⅱ (P<0.05), but no fluctuation was observed between both groups in 4 wks after treatment. The recovery of heart systolic functions (LVFS,LVEF,CI) in Group Ⅰ was more satisfactory than that in Group Ⅱ (P<0.01) ; however, there was no significant difference in the filling fraction of ventricle between both groups(P>0.05).[Conclusion]As one of the main intervening measures, antiviral therapy is very important in children myocarditis of HCMV infection. Ganciclovir shows affirmative therapeutic efficacy for myocarditis caused by HCMV infection.