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[左旋肉碱对重症手足口病患儿血清脑钠肽及N末端脑钠肽前体水平和心功能的影响]

[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].

作者信息

Pan Yan-Zhu, Song Chun-Lan, Guo Yan-Jun, Wang Ling-Ling, Cui Ya-Jie, Ren Yi-Fan

机构信息

Department of Emergency and Critical Medicine, Children's Hospital of Zhengzhou University/Children's Hospital of Henan Province/Zhengzhou Children's Hospital/Zhengzhou Children's Key Laboratory of Critical Care Medicine, Zhengzhou 450003, China.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2018 Aug;20(8):635-640. doi: 10.7499/j.issn.1008-8830.2018.08.007.

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.

摘要

目的

观察左旋肉碱治疗对心功能不全的重症手足口病(HFMD)患儿血清脑钠肽(BNP)和N末端B型利钠肽原(NT-proBNP)水平及心功能的影响。

方法

选取120例重症HFMD患儿,随机等分为常规治疗组和左旋肉碱治疗组。30例健康儿童作为对照组。HFMD患者给予退热及抗病毒治疗作为基础治疗,左旋肉碱治疗组患者在基础治疗的同时给予左旋肉碱辅助治疗。观察两组的治疗效果。对所有受试者,在治疗前后的不同时间点测量血清BNP和NT-proBNP水平以及包括左心室射血分数(LVEF)、缩短分数(FS)和心脏指数(CI)在内的心功能参数。

结果

治疗前,HFMD患者的血清BNP和NT-proBNP水平及心率显著高于对照组,而LVEF、FS和CI显著低于对照组(P<0.05)。治疗后,左旋肉碱治疗组的有效率显著高于常规治疗组(P<0.05)。治疗3天后,左旋肉碱组的血清BNP和NT-proBNP水平、LVEF、FS和CI显著降低(P<0.05);左旋肉碱组的血清BNP和NT-proBNP水平、LVEF、FS和CI显著低于常规治疗组(P<0.05);左旋肉碱治疗组与对照组的血清BNP和NT-proBNP水平、LVEF、FS或CI无显著差异(P>0.05)。治疗5天后,左旋肉碱治疗组与常规治疗组的血清BNP和NT-proBNP水平、LVEF、FS或CI无显著差异(P>0.05)。常规治疗组的心率恢复明显慢于左旋肉碱治疗组(P<0.05)。

结论

作为重症HFMD的辅助治疗,左旋肉碱治疗在降低血清BNP和NT-proBNP水平及改善心功能方面具有满意的短期疗效,从而改善临床结局。

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