Cui Ya-Jie, Song Chun-Lan, Chen Fang, Li Peng, Cheng Yi-Bing
Zhengzhou Children's Hospital, Zhengzhou 450003, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2017 Aug;19(8):908-912. doi: 10.7499/j.issn.1008-8830.2017.08.012.
To investigate the myocardial protective effect of L-carnitine in children with hand, foot and mouth disease (HFMD) caused by Coxsackie A16 virus and possible mechanisms.
A total of 60 HFMD children with abnormal myocardial enzyme after Coxsackie A16 virus infection were enrolled and randomly divided into L-carnitine group and fructose-1,6-diphosphate group (fructose group), with 30 children in each group. The two groups were given L-carnitine or fructose diphosphate in addition to antiviral and heat clearance treatment. Another 30 healthy children who underwent physical examination were enrolled as control group. The changes in myocardial zymogram, malondialdehyde (MDA), superoxide dismutase (SOD), and apoptosis factors sFas and sFasL after treatment were compared between groups.
There was no significant difference in treatment response between the L-carnitine group and the fructose group (P>0.05). One child in the fructose group progressed to critical HFMD, which was not observed in the L-carnitine group. Before treatment, the L-carnitine group and the fructose group had significantly higher indices of myocardial zymogram and levels of MDA, sFas, and sFasL and a significantly lower level of SOD than the control group (P<0.05), while there were no significant differences in these indices between the L-carnitine group and the fructose group (P>0.05). After treatment, the L-carnitine group and the fructose group had significant reductions in the indices of myocardial zymogram and levels of MDA, sFas, and sFasL and a significant increase in the level of SOD (P<0.05); the fructose group had a significantly higher level of creatine kinase (CK) than the control group and the L-carnitine group, and there were no significant differences in other myocardial enzyme indices, MDA, sFas, and sFasL between the L-carnitine group and the fructose group, as well as between the L-carnitine and fructose groups and the control group (P>0.05). SOD level was negatively correlated with aspartate aminotransferase, lactate dehydrogenase (LDH), CK, and creatine kinase-MB (CK-MB) (r=-0.437, -0.364, -0.397, and -0.519 respectively; P<0.05), and MDA level was positively correlated with LDH and CK-MB (r=0.382 and 0.411 respectively; P<0.05).
L-carnitine exerts a good myocardial protective effect in children with HFMD caused by Coxsackie A16 virus, possibly by clearing oxygen radicals and inhibiting cardiomyocyte apoptosis.
探讨左旋肉碱对柯萨奇A16病毒所致手足口病（HFMD）患儿的心肌保护作用及可能机制。
选取60例柯萨奇A16病毒感染后心肌酶异常的HFMD患儿，随机分为左旋肉碱组和1,6-二磷酸果糖组（果糖组），每组30例。两组在抗病毒及清热治疗基础上分别给予左旋肉碱或二磷酸果糖。另选取30例健康体检儿童作为对照组。比较各组治疗后心肌酶谱、丙二醛（MDA）、超氧化物歧化酶（SOD）及凋亡因子sFas和sFasL的变化。
左旋肉碱组与果糖组治疗反应差异无统计学意义（P>0.05）。果糖组有1例患儿进展为重症HFMD，左旋肉碱组未观察到。治疗前，左旋肉碱组和果糖组心肌酶谱指标、MDA、sFas及sFasL水平均显著高于对照组，SOD水平显著低于对照组（P<0.05），而左旋肉碱组与果糖组这些指标差异无统计学意义（P>0.05）。治疗后，左旋肉碱组和果糖组心肌酶谱指标、MDA、sFas及sFasL水平均显著降低，SOD水平显著升高（P<0.05）；果糖组肌酸激酶（CK）水平显著高于对照组和左旋肉碱组，左旋肉碱组与果糖组其他心肌酶指标、MDA、sFas及sFasL差异无统计学意义，左旋肉碱组与果糖组及对照组之间差异亦无统计学意义（P>0.05）。SOD水平与天门冬氨酸氨基转移酶、乳酸脱氢酶（LDH）、CK及肌酸激酶同工酶（CK-MB）呈负相关（r分别为-0.437、-0.364、-0.397和-0.519；P<0.05），MDA水平与LDH和CK-MB呈正相关（r分别为0.38
