【摘要】 目的 观察芪参益气滴丸联合左卡尼汀治疗病毒性心肌炎(VMC)的疗效，并探讨其对患者炎症因子和心功能的影响。方法 选取2021年1月至2023年9月于焦作市第二人民医院就诊的156例VMC患者，依据随机数表法分为对照组和联合组各78例。对照组患者给予左卡尼汀治疗，联合组患者给予芪参益气滴丸联合左卡尼汀治疗，两组患者均连续治疗14 d。比较两组患者治疗14 d后的疗效及治疗前后的心排血量(CO)、左室射血分数(LVEF)、每搏输出量(SV)、氨基末端B型钠尿肽原(NT-proBNP)、肌酸激酶同工酶MB (CK-MB)、心肌肌钙蛋白(c TnI、c Tn T)、白介素-6 (IL-6)、IL-1β、干扰素-γ (INF-γ)、IL-17、免疫球蛋白(IgA、Ig G)、Toll样受体4 (TLR4) m RNA、核因子-κB (NF-κB) m RNA、辅助性T细胞/杀伤性T细胞(CD4+/CD8+)、辅助性T细胞17/调节性T细胞(Th17/Treg)水平，同时比较两组患者治疗期间不良反应发生情况。结果 联合组患者的治疗总有效率为96.15%，明显高于对照组的79.49%，差异有统计学意义(P<0.05)；联合组患者治疗后的SV、LVEF、CO水平分别为(75.39±7.56) m L、(55.36±6.36)%、(5.96±1.36) L/min，明显高于对照组的(62.47±5.97) mL、(45.63±5.43)%、(5.24±1.28) L/min，差异均有统计学意义(P<0.05)；治疗后，联合组患者的cTnI、CK-MB、NT-proBNP、cTnT水平分别为(0.21±0.06)μg/L、(18.93±7.33) U/L、(101.79±15.49) ng/L、(0.57±0.12) ng/mL，明显低于对照组的(0.73±0.31)μg/L、(32.55±10.95) U/L、(154.74±17.85) ng/L、(1.04±0.25) ng/mL，差异均有统计学意义(P<0.05)；治疗后联合组患者的INF-γ、IL-6、IL-1β、IL-17水平分别为(50.39±7.56) ng/mL、(13.47±3.14) ng/mL、(5.79±1.46) ng/mL、(40.29±10.25) ng/mL，明显低于对照组的(67.55±10.54) ng/mL、(17.56±4.25) ng/mL、(10.65±2.03) ng/mL、(61.14±12.37) ng/mL，差异均有统计学意义(P<0.05)；治疗后联合组患者的TLR4 mRNA、NF-κB mRNA水平分别为0.59±0.10、0.43±0.12，明显低于对照组的0.97±0.24、0.89±0.15，差异均有统计学意义(P<0.05)；治疗后联合组患者的IgA、CD4+/CD8+、IgG水平分别为(1.73±0.31) g/L、2.65±0.75、(11.03±1.19) g/L，明显高于对照组的(1.45±0.30) g/L、1.81±0.53、(9.12±1.02) g/L,Th17/Treg水平为0.28±0.08，明显低于对照组的0.75±0.24，差异均有统计学意义(P<0.05)；联合组患者治疗期间的不良反应总发生率为7.69%，略高于对照组的3.85%，差异无统计学意义(P>0.05)。结论 芪参益气滴丸联合左卡尼汀治疗VMC疗效显著，能抑制炎症反应，改善心功能，促进疾病恢复。更多还原

【Abstract】 Objective To observe the efficacy of Qishen Yiqi Dropping Pills combined with L-carnitine in the treatment of viral myocarditis(VMC), and to explore its effects on inflammatory factors and cardiac function in patients.Methods A total of 156 VMC patients who were treated in the Second People’s Hospital of Jiaozuo from January 2021to September 2023 were selected. They were divided into a control group and a combined group according to the random number table method, with 78 patients in each group. The patients in the control group were treated with L-carnitine,while the patients in the combined group were treated with Qishen Yiqi Dropping Pills in combination with L-carnitine.Both groups of patients were treated continuously for 14 days. The efficacy after 14 days of treatment, as well as the cardiac output(CO), left ventricular ejection fraction(LVEF), stroke volume(SV), amino-terminal pro-brain natriuretic peptide(NT-proBNP), creatine kinase MB(CK-MB), cardiac troponin I(cTnI, cTnT), interleukin-6(IL-6), IL-1β, interferon-γ(INF-γ), IL-17, immunoglobulin(IgA, IgG), toll-like receptor 4(TLR4) mRNA, nuclear factor-κ B(NF-κ B)m RNA, helper T cell/killer T cell(CD4+/CD8+), helper T cell 17/regulatory T cell(Th17/Treg) levels before and after treatment were compared between the two groups. At the same time, the incidence of adverse reactions during the treatment period was compared between the two groups. Results The total effective rate in the combined group was96.15%, which was significantly higher than 79.49% in the control group(P<0.05). After treatment, the levels of SV,LVEF, and CO in the combined group were(75.39±7.56) m L,(55.36±6.36)%, and(5.96±1.36) L/min, respectively, which were significantly higher than(62.47±5.97) mL,(45.63±5.43)%, and(5.24±1.28) L/min in the control group(P<0.05). After treatment, the levels of c TnI, CK-MB, NT-proBNP, and cTnT in the combined group were(0.21±0.06) μg/L,(18.93 ±7.33) U/L,(101.79±15.49) ng/L, and(0.57±0.12) ng/mL, respectively, which were significantly lower than(0.73±0.31) μg/L,(32.55±10.95) U/L,(154.74±17.85) ng/L, and(1.04±0.25) ng/m L in the control group(P<0.05). After treatment, the levels of INF-γ, IL-6, IL-1β, and IL-17 in the combined group were(50.39±7.56) ng/m L,(13.47±3.14) ng/m L,(5.79±1.46) ng/mL, and(40.29±10.25) ng/mL, respectively, which were significantly lower than(67.55±10.54) ng/mL,(17.56±4.25) ng/mL,(10.65±2.03) ng/mL, and(61.14±12.37) ng/mL in the control group(P<0.05). After treatment, the levels of TLR4 m RNA and NF-κB m RNA in the combined group were 0.59±0.10 and 0.43±0.12, respectively, which were significantly lower than 0.97±0.24 and 0.89±0.15 in the control group(P<0.05). After treatment, the levels of IgA,CD4+/CD8+, and IgG in the combined group were(1.73±0.31) g/L,(2.65±0.75), and(11.03±1.19) g/L, respectively,which were significantly higher than(1.45±0.30) g/L,(1.81±0.53), and(9.12±1.02) g/L in the control group, while the level of Th17/Treg was 0.28±0.08, significantly lower than 0.75±0.24 in the control group(P<0.05). The total incidence of adverse reactions during treatment in the combined group was 7.69%, which was slightly higher than 3.85% in the control group(P>0.05). Conclusion Qishen Yiqi Dropping Pills combined with L-carnitine is effective in the treatment of VMC, which can inhibit inflammatory reaction, improve cardiac function and promote disease recovery.更多还原