维生素C联合免疫球蛋白治疗儿童病毒性心肌炎的效果

目的探讨维生素C(Vitc)联合免疫球蛋白治疗病毒性心肌炎患儿的临床效果及心肌重塑情况。方法选取2018年1月-2019年12月海南医学院第一附属医院心内科收治的80例病毒性心肌炎患儿,按随机数字表法将其分为研究组(n=40)和对照组(n=40)。对照组给予常规治疗,研究组在此基础上采用Vitc联合免疫球蛋白进行治疗,两组均治疗2周。比较两组患儿临床疗效,血清炎症因子白细胞介素-18(IL-18)、巨噬细胞炎症蛋白-1α(MIP-1α)、细胞间黏附分子-1(ICAM-1)],心肌酶指标肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)]及心脏功能指标心脏指数(CI)、左心室短轴缩短率(LVFS)、左心室射血分数(LVEF)]变化。结果治疗2周后,研究组治疗总有效率为92.50%(37/40),高于对照组的75.00%(30/40),两组比较差异有统计学意义(χ²=4.501,P=0.034);治疗后,两组血清IL-18、MIP-1α、ICAM-1水平较治疗前均降低(P<0.05),且研究组指标水平均低于对照组(P<0.05);治疗后,两组血清CK、CK-MB、LDH、HBDH水平较治疗前均降低(P<0.05),且研究组指标水平均低于对照组(P<0.05);治疗后,两组心脏功能指标CI、LVFS、LVEF水平较治疗前均升高,且研究组指标水平均高于对照组(P<0.05)。结论 Vitc联合免疫球蛋白治疗病毒性心肌炎,可显著降低患儿血清IL-18、MIP-1α、ICAM-1水平,减轻炎症,并能增强患儿心功能,改善心肌重塑,进而有助于提高疗效。

Effect of vitamin C combined with immunoglobulin on treatment of children with viral myocarditis

OBJECTIVE To explore the clinical effect of vitamin C(Vitc) combined with immunoglobulin on treatment of the children with viral myocarditis and observe the status of myocardial remodeling. METHODS A total of 80 children with viral myocarditis who were treated in department of cardiology of the First Affiliated Hospital of Hainan Medical College from Jan 2018 to Dec 2019 were enrolled in the study and randomly divided into the study group with 40 cases and the control group with 40 cases.The control group was given convention therapy, while the study group was treated with Vitc combined with immunoglobulin on basis of treatment of the control group, both groups were treated for 2 weeks.The clinical curative effects, serum inflammatory factors interleukin-18(IL-18), macrophage inflammatory protein-1α(MIP-1α), intercellular adhesion molecule-1(ICAM-1)], myocardial enzyme indexes creatine kinase(CK), creatine kinase isoenzyme(CK-MB), lactate dehydrogenase(LDH), hydroxybutyrate dehydrogenase(HBDH)] and cardiac function indicators cardiac index(CI), left ventricular short axis shortening rate(LVFS), left ventricular ejection fraction(LVEF)] were observed and compared between the two groups of children. RESULTS The total effective rate of treatment of the study group was 92.50%(37/40) after the treatment for 2 weeks, higher than 75.00%(30/40) of the control group, and there was significant difference between the two groups(χ²=4.501,P=0.034).The levels of serum IL-18, MIP-1α and ICAM-1 of the two groups were significantly lower after the treatment than before the treatment(P<0.05), and the levels of above indexes of the study group were significantly lower than those of the control group(P<0.05).The levels of serum CK, CK-MB, LDH and HBDH of the two groups were significantly lower after the treatment than before the treatment(P<0.05), and the levels of above indexes of the study group were significantly lower than those of the control group(P<0.05).The levels of cardiac function indexes CI, LVFS and LVEF of the two groups were higher after the treatment than before the treatment, and the levels of above indexes of the study group were significantly higher than those of the control group(P<0.05). CONCLUSION Vitc combined with immunoglobulin can significantly reduce the levels of serum IL-18, MIP-1α and ICAM-1 of the children with viral myocarditis, alleviate inflammation, boost the cardiac function and improve the myocardial remodeling so as to improve the curative effect.