左卡尼汀对重症手足口病患儿血清脑钠肽、氨基末端前脑钠肽水平及心功能的影响

潘妍竹; 宋春兰; 郭燕军; 王玲玲; 崔亚杰; 任一帆

doi:10.7499/j.issn.1008-8830.2018.08.007

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中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (8) : 635-640. DOI: 10.7499/j.issn.1008-8830.2018.08.007

论著·临床研究

左卡尼汀对重症手足口病患儿血清脑钠肽、氨基末端前脑钠肽水平及心功能的影响

潘妍竹, 宋春兰, 郭燕军, 王玲玲, 崔亚杰, 任一帆

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Effects of L-carnitine on serum levels of brain natriuretic peptide and N-terminal pro-brain natriuretic peptide and cardiac function in children with severe hand-foot-mouth disease

PAN Yan-Zhu, SONG Chun-Lan, GUO Yan-Jun, WANG Ling-Ling, CUI Ya-Jie, REN Yi-Fan

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摘要

目的观察左卡尼汀辅助治疗对心功能异常的重症手足口病患儿血清脑钠肽（BNP）、氨基末端前脑钠肽（NT-proBNP）异常及心脏功能的影响。方法选取重症手足口病患儿120例，按随机数字表法分为常规治疗组（常规组）和左卡尼汀治疗组（左卡组），每组60例。另选取30名健康体检儿童作为健康对照组。两组患儿均给予退热、抗病毒等治疗作为基础治疗，左卡组在基础治疗基础上给予左卡尼汀辅助治疗。观察两组患儿临床疗效及转归；检测对照组儿童及两组患儿治疗前后不同时间点血清BNP、NT-proBNP水平，以及心率（HR）、左室射血分数（LVEF）、射血缩短分数（FS）、心脏指数（CI）等心功能指标。结果治疗前，两组患儿血清BNP、NT-proBNP水平及HR均明显高于对照组，而LVEF、FS、CI均明显低于对照组（P < 0.05）。治疗后，左卡组临床有效率明显高于常规组（P < 0.05）。治疗3 d后，左卡组血清BNP和NT-proBNP水平均明显低于治疗前及常规组（P < 0.05），与对照组相比，差异无统计学意义（P > 0.05）；左卡组LVEF、FS、CI水平均低于治疗前及常规组（P < 0.05），略低于对照组，但差异无统计学意义（P > 0.05）。治疗5 d后，左卡组血清BNP及NT-proBNP水平，以及LVEF、FS、CI与常规组相比，差异均无统计学意义（P > 0.05）。左卡组心率恢复正常时间较常规组明显缩短（P < 0.05）。结论左卡尼汀辅助治疗重症手足口病能够早期有效降低血清BNP、NT-proBNP水平，改善异常的心脏功能，提高临床疗效和改善临床转归。

Abstract

Objective To observe the effects of L-carnitine treatment on serum levels of brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) and cardiac function in children with heart dysfunction and severe hand-foot-mouth disease (HFMD).Methods A total of 120 children with severe HFMD were enrolled and randomly and equally divided into routine treatment group and L-carnitine treatment group. Thirty healthy children served as the control group. HFMD patients were given anti-fever and antiviral treatment as the basic treatment, while the patients in the L-carnitine treatment group were given L-carnitine as an adjuvant treatment to the basic treatment. Treatment outcomes were observed in the two groups. For all the subjects, serum levels of BNP and NT-proBNP and cardiac function parameters including left ventricular ejection fraction (LVEF), fractional shortening (FS), and cardiac index (CI) were measured at different time points before and after treatment.Results Before treatment, HFMD patients had significantly higher serum levels of BNP and NT-proBNP and heart rate but significantly lower LVEF, FS, and CI compared with the control group (P < 0.05). After treatment, the L-carnitine treatment group had a significantly higher response rate than the routine treatment group (P < 0.05). After 3 days of treatment, the serum levels of BNP and NT-proBNP, LVEF, FS, and CI were significantly reduced in the L-carnitine group (P < 0.05); the L-carnitine group had significantly lower serum levels of BNP and NT-proBNP, LVEF, FS, and CI than the routine treatment group (P < 0.05); there were no significant differences in the serum levels of BNP and NT-proBNP, LVEF, FS, or CI between the L-carnitine treatment and control groups (P > 0.05). After 5 days of treatment, there were no significant differences in the serum levels of BNP and NT-proBNP, LVEF, FS, or CI between the L-carnitine treatment and routine treatment groups (P > 0.05). Heart rate recovery was significantly slower in the routine treatment group than in the L-carnitine treatment group (P < 0.05).Conclusions As an adjuvant therapy for severe HFMD, L-carnitine treatment has satisfactory short-term efficacy in reducing the serum levels of BNP and NT-proBNP and improving cardiac function, thus improving clinical outcomes.

导出引用

潘妍竹, 宋春兰, 郭燕军, 王玲玲, 崔亚杰, 任一帆. 左卡尼汀对重症手足口病患儿血清脑钠肽、氨基末端前脑钠肽水平及心功能的影响[J]. 中国当代儿科杂志. 2018, 20(8): 635-640 https://doi.org/10.7499/j.issn.1008-8830.2018.08.007

PAN Yan-Zhu, SONG Chun-Lan, GUO Yan-Jun, WANG Ling-Ling, CUI Ya-Jie, REN Yi-Fan. Effects of L-carnitine on serum levels of brain natriuretic peptide and N-terminal pro-brain natriuretic peptide and cardiac function in children with severe hand-foot-mouth disease[J]. Chinese Journal of Contemporary Pediatrics. 2018, 20(8): 635-640 https://doi.org/10.7499/j.issn.1008-8830.2018.08.007

参考文献

[1] 张静, 靳妍, 孙军玲, 等. 手足口病重症病例临床分期与结局分析[J]. 中华流行病学杂志, 2017, 38(5):651-655.
[2] Xing W, Liao Q, Viboud C, et al. Hand, foot, and mouth disease in China, 2008-12:an epidemiological study[J]. Lancet Infect Dis, 2014, 14(4):308-318.
[3] Huang J, Liao Q, Ooi MH, et al. Epidemiology of recurrent hand, foot and mouth disease, China, 2008-2015[J]. Emerg Infect Dis, 2018, 24(3):432-442.
[4] 蒙小燕. 磷酸肌酸钠在手足口病并发心肌损害的临床效果观察及对机体免疫的影响研究[J].中国医学工程, 2018, 26(2):76-79.
[5] 崔亚杰, 宋春兰, 陈芳, 等. 左卡尼汀对柯萨奇A16型病毒感染手足口病的心肌保护作用[J]. 中国当代儿科杂志, 2017, 19(8):908-912.
[6] 宋春兰, 崔亚杰, 陈芳, 等. 左卡尼汀对手足口病心肌酶谱异常的影响[J]. 实用医学杂志, 2017, 33(19):3290-3294.
[7] 王鑫璐, 陈亚丹, 付秀娟. 左卡尼汀治疗心力衰竭疗效的Meta分析[J]. 中国药房, 2016, 27(27):3818-3821.
[8] Bakeet MA, Mohamed MM, Allam AA, et al. Childhood cardiomyopathies:a study in tertiary care hospital in Upper Egypt[J]. Electron Physician, 2016, 8(11):3164-3169.
[9] 中华人民共和国卫生部. 手足口病诊疗指南(2010年版)[J]. 国际呼吸杂志, 2010, 30(24):1473-1475.
[10] 卫生部手足口病临床专家组. 肠道病毒71型(EV71)感染重症病例临床救治专家共识[J]. 中华儿科杂志, 2011, 49(9):675-678.
[11] 王晓华, 刘维婵. 小儿手足口病并暴发性心肌炎4例报告[J]. 临床儿科杂志, 2003, 21(1):9.
[12] 黄娇甜, 祝益民, 卢秀兰, 等. 重症手足口病并心肌损伤的临床特征[J]. 实用儿科临床杂志, 2012, 27(18):1414-1417.
[13] Chang LY, Hsia SH, Wu CT, et al. Outcome of enterovirus 71 infections with or without stage-based management:1998 to 2002[J]. Pediatr Infect Dis J, 2004, 23(4):327-332.
[14] 谷芬. 重症手足口病并发心肺衰竭321例临床分析[J]. 临床儿科杂志, 2017, 35(4):264-267.
[15] 石军. 不同类型手足口病患儿心功能改变情况研究[J].中国全科医学, 2013, 16(5):490-492.
[16] 彭红艳, 祝益民, 胥志跃, 等. N端脑钠肽原评估重症手足口病患儿病情的价值[J]. 中华急诊医学杂志, 2015, 24(6):602-607.
[17] 刘晓, 夏焙, 冯霞, 等. EV71手足口病神经源性心脏功能不全的实时三维超声心动图检测[J]. 中华医学超声杂志(电子版), 2010, 7(11):1844-1852.
[18] 沙维利. 儿童心力衰竭的诊断及治疗[J]. 世界最新医学信息文摘(电子版), 2013, 13(13):91, 96.
[19] Fu YC, Chi CS, Jan SL, et al. Pulmonary edema of enterovirus 71 encephalomyelitis is associated with left ventricular failure:implications for treatment[J]. Pediatr Pulmonol, 2003, 35(4):263-268.
[20] 王美芬, 杜曾庆, 陈韬, 等. 不同危重程度手足口病患儿儿茶酚胺、S-100蛋白和D-乳酸水平变化的研究[J]. 中华传染病杂志, 2016, 34(5):302-303.
[21] 刘艳霞. 测定儿茶酚胺对手足口病的临床意义[J]. 齐齐哈尔医学院学报, 2017, 38(15):1792-1793.
[22] Wan SH, McKie PM, Schirger JA, et al. Chronic peptide therapy with B-type natriuretic peptide in patients with pre-clinical diastolic dysfunction (stage B heart failure)[J]. JACC Heart Fail, 2016, 4(7):539-547.
[23] Ndumele CE, Matsushita K, Sang Y, et al. N-terminal pro-brain natriuretic peptide and heart failure risk among individuals with and without obesity:the atherosclerosis risk in communities (ARIC) study[J]. Circulation, 2016, 133(7):631-638.
[24] Vaduganathan M, Claggett B, Packer M, et al. Natriuretic peptides as biomarkers of treatment response in clinical trials of heart failure[J]. JACC Heart Fail, 2018, 6(7):564-569.
[25] 苑淑静. 心脏彩超在多病因慢性心力衰竭诊断中的临床效果观察[J]. 世界最新医学信息文摘, 2016, 16(55):299.
[26] 中国医师协会急诊医师分会, 中国心胸血管麻醉学会急救与复苏分会. 中国急性心力衰竭急诊临床实践指南(2017)[J]. 中华急诊医学杂志, 2017, 26(12):1347-1357.
[27] 许娜, 夏焙, 周蔚, 等. 儿童超声心动图测量指标正常参考值的建立及临床意义[J]. 中华医学超声杂志(电子版), 2012, 9(1):40-49.
[28] Wang ZY, Liu YY, Liu GH, et al. I-Carnitine and heart disease[J]. Life Sci, 2018, 194:88-97.