目的 探讨黄芪颗粒联合环磷腺苷治疗儿童病毒性心肌炎的临床疗效。方法 纳入2023年1月—2025年4月南京医科大学第二附属医院收治的96例病毒性心肌炎患儿，按随机数字表法分为对照组和治疗组，每组各48例。对照组静脉滴注注射用环磷腺苷，1 mg/kg加入5%葡萄糖注射液100 mL，1次/d。在对照组基础上，治疗组口服黄芪颗粒，3～6岁患儿10 g/次，7～12岁患儿15 g/次，3次/d。两组患儿疗程均为14 d。观察两组患儿临床疗效，比较两组典型症状缓解时间，以及治疗前后心律失常和ST-T改变的发生率、中性粒细胞与淋巴细胞比值（NLR）和血清心肌酶谱[心肌肌钙蛋白Ⅰ（cTnⅠ）、cTnT、乳酸脱氢酶（LDH）、肌酸激酶同工酶（CK-MB）]、白细胞介素-6（IL-6）水平。结果 治疗后，治疗组患者总有效率明显高于对照组（95.83% vs 83.33%，P＜0.05）。治疗后，治疗组胸痛、胸闷、心悸、叹气样呼吸、乏力缓解时间显著短于对照组（P＜0.05）。治疗后，两组心律失常、ST-T改变的发生率、NLR、血清心肌酶谱和IL-6水平都比治疗前降低（P＜0.05），且治疗组这些指标显著低于对照组（P＜0.05）。结论 黄芪颗粒联合环磷腺苷治疗儿童病毒性心肌炎，能加快症状缓解，进一步抑制患儿机体炎症反应，改善心电图异常及心肌损伤，且无额外安全风险。

Objective To investigate the clinical efficacy of Astragalus Granules combined with adenosine cyclophosphate in the treatment of viral myocarditis in children. Methods A total of 96 children diagnosed with viral myocarditis admitted to the Second Affiliated Hospital of Nanjing Medical University from January 2023 to April 2025 were enrolled and randomly divided into control group and treatment group using a random-number table, with 48 cases in each group. Children in the control group received intravenous infusion of adenosine cyclophosphate for injection at a dose of 1 mg/(kg·time) dissolved in 100 mL of 5% glucose injection, once daily. On the basis of the control regimen, the treatment group was additionally given oral Astragalus Granules: 10 g per dose for children aged 3 — 6 years and 15 g per dose for children aged 7 — 12 years, three times daily. Both groups received a 14-day treatment course. The clinical efficacy, time-to-relief of typical symptoms, incidence of arrhythmia and ST-T changes before and after treatment, neutrophil-to-lymphocyte ratio (NLR), serum myocardial enzyme profiles [cardiac troponin Ⅰ (cTnⅠ), cardiac troponin T (cTnT), lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB)] and interleukin-6 (IL-6) levels were compared between the two groups. Results After treatment, the overall response rate in the treatment group was significantly higher than that in the control group (95.83% vs 83.33%, P < 0.05). After treatment, the relief times of chest pain, chest tightness, palpitations, sighing-like breathing and fatigue in treatment group were significantly shorter than those in control group (P < 0.05). The incidences of arrhythmia and ST-T changes, NLR values, myocardial enzyme levels and IL-6 concentrations were significantly decreased in both groups after therapy (P < 0.05), and these indicators were substantially lower in the treatment group than in the control group (P < 0.05). Conclusion The combined therapy of Astragalus Granules and adenosine cyclophosphate can accelerate symptom remission, suppress inflammatory responses, ameliorate electrocardiographic abnormalities and myocardial injury in children with viral myocarditis, without bringing additional safety risks.

R972;R985

南京医科大学科技发展基金资助项目（2017NJMU038）