目的 探讨荣心丸联合环磷腺苷治疗儿童急性病毒性心肌炎临床疗效。方法 选择2019年7月—2020年7月在郑州大学附属儿童医院治疗的98例急性病毒性心肌炎患儿，根据就诊顺序分成对照组（49例）和治疗组（49例）。对照组静脉滴注注射用环磷腺苷，1 mg/kg加入100 mL生理盐水，1次/d。治疗组在对照组的基础上口服荣心丸，1～3岁患儿3 g/次，3～6岁4.5 g/次，6岁以上6 g/次，3次/d。两组患儿治疗2周。观察两组患者临床疗效，比较治疗前后两组患者临床症状改善时间，血清C反应蛋白（hs-CRP）、白细胞介素-18（IL-18）、降钙素原（PCT）、人巨噬细胞移动抑制因子（MIF）、人心型脂肪酸结合蛋白（H-FABP）、心肌肌钙蛋白（cTnI）、肌酸激酶（CK）、磷酸肌酸激酶同工酶（CKMB）、乳酸脱氢酶（LDH）水平，及心功能指标左室射血分数（LVEF）、每搏输出量（SV）、心排血量（CO）。结果 经治疗，对照组总有效率为81.63%，显著低于治疗组的97.96%（P<0.05）。治疗组患儿临床症状改善时间均明显早于对照组（P<0.05）。经治疗，两组患儿血清hs-CRP、IL-18、PCT、MIF、H-FABP、cTnI、CK、CK-MB和LDH水平均显著下降（P<0.05），且治疗组降低最显著（P<0.05）。经治疗，两组患儿LVEF、SV、CO均明显升高（P<0.05），且治疗组患儿心功能明显好于对照组（P<0.05）。结论 荣心丸联合注射用环磷腺苷治疗急性病毒性心肌炎患儿可有效改善临床症候及心功能，降低血清炎症因子水平，进而减轻心肌损伤，具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Rongxin Pills combined with adenosine cyclophosphate in treatment of children with acute viral myocarditis. Methods Children (98 cases) with acute viral myocarditis in Children’s Hospital Affiliated to Zhengzhou University from July 2019 to July 2020 were divided into control (49 cases) and treatment (49 cases) groups based on visiting order. Children in the control group were iv administered with Adenosine Cyclophosphate for injection, 1 mg/kg added into 100 mL normal saline, once daily. Children in the treatment group were po administered with Rongxin Pills on the basis of the control group, 3 g/time for 1 — 3 years old, 4.5 g/time for 3 — 6 years old, 6 g/time for more than 6 years old, three times daily. Children in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the improvement time of clinical symptoms, and the serum levels of hs-CRP, IL-18, PCT, MIF, H-FABP, cTnI, CK, CK-MB and LDH, and the cardiac function indexes of LVEF, SV and CO in two groups before and after treatment were compared. Results After treatment, the effective rate in the control group was 81.63%, which was significantly lower than 97.96% in the treatment group (P<0.05). After treatment, the improvement time of clinical symptoms in the treatment group was significantly earlier than that in the control group (P<0.05). After treatment, the serum levels of hs-CRP, IL-18, PCT, MIF, H-FABP, cTnI, CK, CK-MB and LDH were significantly decreased in two groups (P<0.05), especially in the treatment group (P<0.05). After treatment, LVEF, SV, and CO were significantly increased in two groups, and the cardiac function in the treatment group was significantly better than that in the control group (P<0.05). Conclusion Rongxin Pills combined with adenosine cyclophosphate in treatment of children with acute viral myocarditis can effectively improve the clinical symptoms and cardiac function, reduce the level of serum inflammatory factors, and then reduce myocardial injury, which has a certain clinical application value.

R985

河南省医学科技攻关项目（2018020617）