维生素C联合免疫球蛋白对病毒性心肌炎患儿心肌损伤程度及miR-21和miR-451表达水平的影响

目的探讨维生素C联合免疫球蛋白对病毒性心肌炎(VMC)患儿心肌损伤程度及miR-21、miR-451的影响。方法前瞻性选取2017年1月至2019年1月间在天津儿童医院接受治疗的VMC患儿90例,经随机数表法分为对照组、研究组各45例。对照组患儿接受免疫球蛋白+常规治疗,研究组患儿接受维生素C+免疫球蛋白+常规治疗,治疗2个疗程后评估疗效,对比两组患儿的血清心肌损伤标志物[心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)、N端前脑钠肽前体(NT-pro BNP)],炎症介质[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白介素-18(IL-18)],miR-21,-451表达水平的差异,判定治疗效果并记录用药不良反应。结果治疗后,研究组患者血清中cTnI、cTnT、NT-pro BNP的水平低于对照组患儿;血清中hs-CRP、TNF-α、IL-18的水平低于对照组患儿;血清中miR-21的水平低于对照组患儿,miR-451的水平高于对照组患儿(P <0. 05)。两组患儿的疗效分级差异有统计学意义(P <0. 05),总有效率差异无统计学意义(P>0. 05)。两组患儿治疗期间均未见明显药物不良反应发生。结论维生素C联合免疫球蛋白可有效减轻VMC患儿的心肌损伤,减少炎症因子释放,其机制可能与miR-21,miR-451表达改变相关。

Effects of vitamin C combined with immunoglobulin on myocardial injury and miR-21,miR-451 in children with viral myocarditis

Objective To investigate the effect of vitamin C combined with immunoglobulin on myocardial injury and mir-21,miR-451 in children with viral myocarditis( VMC). Methods 90 cases of VMC children treated in our hospital during January 2017 to January 2019 were divided into Control group and Study group by random number table method with 45 cases in each group. Children in control group were treated with immunoglobulin + conventional treatment,while those in study group were treated with vitamin C + immunoglobulin + conventional treatment. The efficacy was evaluated after two courses of treatment. After two courses of treatment,two group children’s serum myocardial injury markers [cardiac troponin I( cTnI),cardiac troponin T( cTnT),sodium n-terminal pro-brain peptide precursor( NT-proBNP) ],inflammation medium [hypersensitive c-reactive protein( hs-CRP),tumor necrosis factor α( TNF-α),interleukin-18( IL-18) ],miR-21,miR-451 expression levels were compared. The treatment effect and adverse reactions were recorded. Results After treatment,serum levels of cTnI,cTnT,NT-proBNP in Study group were lower than those in control group( P < 0. 05). Serum levels of hs-CRP,TNF-α,and IL-18 were lower than those in control group( P < 0. 05). Serum level of miR-21 was lower than that of control group,miR-451 was higher than that of control group( P < 0. 05). There was a statistically significant difference in efficacy grading between two groups( P < 0. 05),but no statistically significant difference in total effective rate( P > 0. 05). No obvious adverse drug reactions occurred during the treatment in both groups. Conclusion Vitamin C combined with immunoglobulin can effectively reduce myocardial injury in VMC children,and the mechanism may be related to the expression changes of miR-21 and miR-451.