左卡尼汀治疗心肌炎的临床效果与安全性观察

目的对心肌炎患者采用左卡尼汀治疗的效果和安全性进行探究。方法研究对象以2018年7月-2019年9月收治的心肌炎患者82例为对象,以随机数字表划分为常规组和研究组,两组患者每组41例。采用常规治疗方式对常规组进行治疗,在此基础上,采用左卡尼汀对研究组进行治疗。在治疗结束后,观察并比较临床疗效和用药过程的安全问题。结果研究组的治疗总有效率为97.6%,但常规组的治疗总有效率只有80.5%,从结果来看研究组的治疗有效率更高,效果更佳突出,组间结果差异对比(P <0.05)。在不良反应方面,研究组的不良反应(4.9%)虽然比常规组(2.4%)更高,然而从统计学结果来看差异无统计学意义(P> 0.05)。结论针对心肌炎患者采用左卡尼汀进行治疗具有很好的效果,而且具有很高的安全性。     

Myocarditis in the pediatric population: A review

Myocarditis has a variable clinical presentation and there is still debate regarding accurate diagnostic criteria. Adding to the controversy surrounding this diagnosis, there is no clear consensus for the treatment or ongoing follow‐up of patients with myocarditis. All of this makes the diagnosis and management of myocarditis a particular challenge in the pediatric population. Furthermore, the literature with respect to this topic is dynamic and ever‐changing. In this review article, we aim to review and summarize the common clinical presentations of myocarditis, along with the latest recommendations for diagnostic criteria, treatment, and follow‐up of patients with myocarditis.     

王有鹏教授应用当归六黄汤治疗病毒性心肌炎经验

病毒性心肌炎是小儿常见的心系疾病,是病毒感染后引起的心肌损伤,目前西医治疗本病尚无特效药物,王有鹏教授从中医整体观念出发,运用辨病、辨证与辨体相结合的方法,结合中医阴阳平衡的理论,注重心脾两脏辨证关系来治疗本病,获得较好疗效。王有鹏教授借鉴古方当归六黄汤的病因病机,寒温并用,补清兼施,做到异病同治,疗效显著,值得同道探讨。     

益气养阴解毒方联合环磷腺苷葡胺注射液治疗病毒性心肌炎35例

目的:探讨益气养阴解毒方联合环磷腺苷葡胺注射液对病毒性心肌炎患者心功能及外周血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)和干扰素-γ(interferon-γ,IFN-γ)水平的影响。方法:将70例病毒性心肌炎患者按照随机数字法分为对照组和观察组,每组各35例。两组患者均给予常规治疗,对照组在常规治疗的基础上给予环磷腺苷葡胺注射液静脉滴注,观察组在对照组的基础上联合益气养阴解毒方治疗。比较两组患者的临床疗效及治疗前后左室短轴缩短分数(left ventricular shortening fraction,LVFS)、左心室射血分数(left ventricular ejection fraction,LVEF)、心脏指数(cardiac index,CI)、TNF-α、TGF-β1和IFN-γ水平。结果:观察组有效率为88.57%,对照组有效率为68.57%,两组患者有效率比较,差异有统计学意义(P<0.05)。两组患者治疗后LVEF、LVFS高于本组治疗前,且观察组高于对照组,差异具有统计学意义(P<0.05)。两组患者治疗后TGF-β1、TNF-α水平低于治疗前比较,IFN-γ高于治疗前,且观察组TGF-β1、TNF-α低于对照组,IFN-γ高于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:益气养阴解毒方联合环磷腺苷葡胺注射液治疗病毒性心肌炎疗效更显著,可减轻机体的炎症反应,恢复患者心功能。     

益心舒胶囊治疗病毒性心肌炎气阴两虚证的抗氧化、抗炎作用观察

目的:探讨益心舒胶囊治疗病毒性心肌炎(VMC)气阴两虚证的临床疗效及抗氧化、抗炎的作用。方法:将132例亚急性期VMC患者,采用随机按数字表法分为对照组和观察组各66例。两组均注射用磷酸肌酸钠,1 g/次,1次/d,静脉滴注,连续治疗14 d;辅酶Q10胶囊,1粒/次,3次/d,饭后服用;盐酸曲美他嗪片,1片/次,3次/d,三餐时服用;重症患者,给予地塞米松磷酸钠注射液,10～20 mg/次,1次/d,静脉滴注,连续治疗14 d。对照组口服稳心颗粒,每次1袋,3次/d。观察组口服益心舒胶囊,3粒/次,3次/d。两组疗程均连续治疗8周。监测血清肌钙蛋白I(cTnI)和心肌肌酸磷酸激酶(CK-MB),记录治疗后cTnI,CK-MB的复常率;进行治疗前后心电图检查,记录心电图复常率;进行治疗前后气阴两虚证评分;检测治疗前后肌酸磷酸激酶(CPK),羟丁酸脱氢酶(HBDH),乳酸脱氢酶(LDH)和天门冬氨酸氨基转移酶(AST)水平;进行治疗前后超声心动图检查,记录治疗前后左心室射血分数(LVEF),心脏指数(CI)和舒张早期/舒张晚期最大血流速度(E/A);检测治疗前后超氧化物歧化酶(SOD),丙二醛(MDA),谷胱甘肽过氧化物酶(GSH-Px),干扰素-γ(IFN-γ),白细胞介素-10(IL-10),IL-17和IL-35水平。结果:采用秩和检验分析两组临床疗效,观察组优于对照组(Z=2. 151,P0. 05);观察组cTnI,CK-MB和心电图复常率分别为82. 26%(51/62),90. 32%(56/62)和80. 65%(50/62)分别高于对照组的65. 00%(39/60),73. 33%(44/60)和63. 33%(38/60)(P0. 05);观察组患者血清cTnI,CK-MB,CPK,HBDH,LDH和AST水平均低于对照组(P0. 01);观察组患者LVEF,CI和E/A均高于对照组(P0. 01);观察组SOD和GSH-Px水平均高于对照组(P0. 01),MDA水平低于对照组(P0. 01);观察组IL-10和IL-35水平均高于对照组(P0. 01),IFN-γ和IL-17水平均低于对照组(P0. 01)。结论:在西医常规治疗的基础上,加用益心舒胶囊治疗亚急性期VMC气阴两虚证患者,可通过抗炎和抗氧化作用而保护心肌,临床能起到降低心肌酶,促进心电图、心酶等恢复,改善心功能,提高临床治疗的效果。     

Fatal unexpected death due to X-linked lymphoproliferative disease

X-linked lymphoproliferative disease (XLP) is a rare immunodeficiency disease characterized by severe immune disorder and extreme vulnerability to Epstein-Barr virus (EBV) infections. Here we report a 14-month-old Chinese boy presenting with fulminant infectious mononucleosis (FIM) following EBV infection, and died of hepatic failure within one week of disease progression. Postmortem examination revealed icterus, ascites, extensive enlarged mesenteric lymph nodes and hepatosplenomegaly. Histopathological examination showed diffuse proliferation of cytotoxic T lymphoid cells and hemophagocytosis in multiple organs. The family history revealed his brother had died under similar circumstances at 5 five years of age. The cause of death of the boy was ascribed to XLP. To the best of our knowledge, there is few autopsy-confirmed XLP case in the forensic practice. The complicated manifestations and systemic pathological changes should be well recognized by clinicians and forensic pathologists.     

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??Fulminant hepatic failure refers to the severe liver function damage?? caused by multiple factors in the onset of 8 weeks of hepatic encephalopathy and severe blood coagulation dysfunction?? with onset nasty?? bad prognosis?? and high fatality rate. For the past many years,there have been no effective treatment methods. In recent years?? artificial liver support system and liver transplantation in the treatment of fulminant liver failure have more and more been taken seriously. In this paper?? the etiology?? diagnosis and treatment of FHF in recent research will be summarized.