葛根素联合左卡尼汀对心肌炎患儿氧化应激态及炎症因子的影响-现代医学

葛根素联合左卡尼汀对心肌炎患儿氧化应激态及炎症因子的影响

单位：1. 泰州市第三人民医院儿科, 江苏南京 225321;
2. 南京市儿童医院急诊科, 江苏南京 210008

分类号：R542.21;R453

出版年·卷·期（页码）：2017·36·第九期（1235-1240）

摘要：

目的：探究葛根素联合左卡尼汀对心肌炎患儿氧化应激态及炎症因子的影响。方法：随机选取2014年3月至2016年3月进行治疗的病毒性心肌炎患儿84例，按照数字随机表法分为观察组和对照组各42例，对照组使用左卡尼汀治疗，观察组在对照组的基础上使用葛根素治疗。检测两组患者的心肌酶谱指标、氧化指标、炎症因子水平以及Th17的细胞频率。结果：治疗后观察组的cTnT、CK-MB、MCP-1以及H-FABP水平显著低于对照组（P<0.05），并且观察组的治疗有效率显著高于对照组（χ²=6.354，P=0.000）；治疗后观察组的MAD水平显著低于对照组（t=5.365，P=0.000），GSH和SOD值显著高于对照组（t=5.184，P=0.000；t=5.746，P=0.000）；治疗后TNF-α、IL-23、IL-17、IL-6、IL-1β水平观察组均显著低于对照组（t=6.464，P=0.000；t=6.833，P=0.000；t=6.833，P=0.000；t=6.438，P=0.000；t=7.463，P=0.000）；观察组Th17的细胞频率显著低于对照组（t=5.746，P=0.000）。结论：联合使用葛根素和左卡尼汀可有效降低病毒性心肌炎患儿的心肌酶水平，并调节氧化应激状态，抑制炎症因子，具有良好的治疗效果。

Objective: To investigate the effect of puerarin combined with levocarnitine on oxidative stress and inflammatory factors in children with myocarditis. Methods: 84 cases of children with viral myocarditis who were treated in hospital from March 2014 to March 2016 were randomly divided into observation group and control group according to the method of digital random table, and 42 cases in each group. The children in the control group were treated with levocarnitine, the children in the observation group were treated with puerarin on the base of control group. Myocardial zymogram, oxidative index, inflammatory factor level and Th17 cell frequency were measured in the two groups. Results: After treatment, the levels of cTnT, CK-MB, MCP-1 and H-FABP in the observation group were significantly lower than those in the control group (P<0.05). The effective rate of the observation group was significantly higher than that of the control group (χ²=6.354, P=0.000). After treatment, the level of MAD in the observation group was significantly lower than that in the control group(t=5.365, P=0.000), GSH and SOD were significantly higher than those in the control group (t=5.184, P=0.000;t=5.746, P=0.000). After treatment, the levels of TNF-α, IL-23, IL-17, IL-6, IL-1β of the observation group were significantly lower than those of the control group(t=6.464, P=0.000;t=6.833, P=0.000;t=6.833, P=0.000;t=6.438, P=0.000;t=7.463, P=0.000). The frequency of Th17 cells in the observation group was significantly lower than that in the control group(t=5.746, P=0.000). Conclusion: Combined use of puerarin and levocarnitine can effectively reduce myocardial enzymes levels in children with viral myocarditis, and regulate oxidative stress, inhibit the levels of inflammatory factors, which has a good therapeutic effect.

参考文献：

[1] LI Y,HU Z,HUANG Y,et al.Characterization of the Myocarditis during the worst outbreak of dengue infection in China[J].Medicine,2016,95(27):e4051.
[2] ANTONIAK S,MACKMAN N.Coagulation,protease activated receptors and viral myocarditis[J].J Cardiovasc Transl Res,2014,7(2):203-211.
[3] 张园,冯阳春,黄艳春.新疆维吾尔族宫颈癌患者人乳头瘤病毒感染与外周血中Th17细胞水平的相关性研究[J].东南大学学报:医学版,2016,35(5):699-703.
[4] RAJASEKHAR D,VANAJAKSHAMMA V,RAVIKANTH A,et al.Clinical efficacy of l-carnitine in scorpion sting myocarditis:a randomized study[J].J Ind Col Card,2014,4(1):14-17.
[5] 祁佳,唐跃年,张宇锋,等.葛根素注射液联合黄芪注射液治疗病毒性心肌炎随机对照临床研究Meta分析[J].中医药导报,2016,16(5):107-109.
[6] CAI Z,LUO Y,PEDIATRICS D O.The role of IL-23/IL-17 inflammatory axis in viral myocarditis in mice[J].Journal of Clinical Pediatrics,2014,32(4):360-363.
[7] 中华医学会儿科学分会心血管学组.病毒性心肌炎诊断标准(修订草案)[J].中国实用儿科杂志,2000,38(5):75.
[8] ZHANG J,GUO W,TIAN B,et al.Puerarin attenuates cognitive dysfunction and oxidative stress in vascular dementia rats induced by chronic ischemia[J].Int J Clin Exp Pathol,2015,8(5):4695-4704.
[9] HEIDECKER B,KITTLESON M M,KASPER E K,et al.Transcriptomic biomarkers for the accurate diagnosis of myocarditis[J].Circulation,2011,123(11):1174-1184.
[10] 罗进光,张嘉宁,王智彬,等.参麦注射液与曲美他嗪和左卡尼汀联合治疗急性病毒性心肌炎的临床疗效及对血清TNF-α和IL-6水平的影响[J].中华医院感染学杂志,2017,27(3):576-579.
[11] MYERS J M,CUNNINGHAM M W,FAIRWEATHER D,et al.Autoimmune myocarditis,valvulitis,and cardiomyopathy[J].Curr Protoc Immunol,2013,13(15):1451.
[12] 梁俊晖,张常娥,LIANG J H,等.葛根素对骨性关节炎模型兔的作用机制研究[J].检验医学与临床,2016,13(20):2884-2886.
[13] MYERS J M,COOPER L T,KEM D C,et al.Cardiac myosin-Th17 responses promote heart failure in human myocarditis[J].JCI Insight,2016,1(9):e85851.
[14] MACHINO-OHTSUKA T,TAJIRI K,KIMURA T,et al.Tenascin-C aggravates autoimmune myocarditis via dendritic cell activation and Th17 cell differentiation[J].J Am Heart Assoc,2014,3(6):e001052.
[15] 梁艺.葛根素对急性冠状动脉综合征患者炎性因子的影响[J].西南国防医药,2016,26(10):1196-1197.
[16] 行海舰.葛根素联合左卡尼汀治疗小儿病毒性心肌炎的临床疗效分析[J].陕西中医,2015(10):1297-1298.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录