Objective To investigate the clinical efficacy of L-carnitine treatment in children with heart failure complicated by severe infection and abnormal brain natriuretic peptide (BNP) levels.A secondary aim of the study was to assess the effect of L-carnitine on serum BNP levels and examine its cardiac protective properties.Methods One hundred children with heart failure,complicated by severe infection and abnormal BNP levels,who were treated at Department of ICU of Zhengzhou Children's Hospital in 2016 were enrolled and into the study.They were randomly divided into Groups A,B,C and control group,with 25 children in each group.The control group was administered with sodium creatine phosphate (50-100 mg·kg-1·d-1);Group A was administered with a low dose of L-carnitine (0.1 g·kg-1·d-1);Group B was administered with a high dose of L-carnitine (0.2 g·kg-1·d-1);Group C was administered with sodium creatine phosphate (50-100 mg·kg-1·d-1) combined with a low dose of L-carnitine (0.1 g·kg-1·d-1).Treatment lasted for 7 days.The clinical efficacy of the treatment was evaluated at day 7 in the four groups.Serum BNP,creatine kinase-MB (CK-MB),MDA,glutathione peroxidase (GSH-Px),TG levels and left ventricular ejection fraction (LVEF) were evaluated at before treatment,and day 3,7 of treatment.Results There was no significant difference observed in clinical efficacy between the four groups on day 7 of treatment (H=1.299,P=0.729).Before treatment,there were no significant differences in serum BNP,CK-MB,MDA, GSH-Px,TG levels and LVEF among the four groups (P>0.05).When compared with the control group at day 3 and day 7 of treatment,BNP,CK-MB,MDA and TG levels were significantly lower in Groups A,B and C (P<0.05),and LVEF and GSH-Px levels were significantly higher in Groups A,B and C (P<0.05).When compared with Group A,the levels of BNP, CK-MB,MDA and TG were significantly lower in Group B and C,whilst GSH-Px level and LVEF in Group B and C were significantly higher (P<0.05).The percentage decline in serum BNP level on day 3 of treatment than that of before treatment in Groups A,B and C were higher than that in the control group (P<0.05).Conclusion The use of L-carnitine treatment in children with heart failure complicated by severe infection and abnormal BNP levels provides significant cardiac protection.Its use can significantly improve BNP,CK-MB,MDA,GSH-Px,TG levels,and heart function,which can ultimately improve prognosis.%目的 探讨左卡尼汀治疗并发血清脑钠肽(BNP)水平异常的重症感染致心力衰竭患儿的临床疗效及对血清BNP水平和心脏保护作用的影响.方法 选取2016年郑州市儿童医院重症监护室收治的并发BNP水平异常的重症感染致心力衰竭患儿100例为研究对象,采用随机数字表法分为A、B、C组和对照组,每组各25例.对照组给予磷酸肌酸钠50~100 mg·kg-1·d-1;A组给予小剂量左卡尼汀(0.1 g·kg-1·d-1);B组给予大剂量左卡尼汀(0.2 g·kg-1·d-1);C组给予磷酸肌酸钠(50~100 mg·kg-1·d-1)联合小剂量左卡尼汀(0.1 g·kg-1·d-1).7 d为1个疗程.观察4组治疗7 d后临床疗效,治疗前及治疗3、7 d血清BNP、肌酸激酶同工酶(CK-MB)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)、三酰甘油(TG)水平及左心室射血分数(LVEF)等指标变化.结果 治疗后7 d 4组患儿临床疗效比较,差异无统计学意义(H=1.299,P=0.729).治疗前,4组血清BNP、CK-MB、MDA、GSH-Px、TG水平及LVEF比较,差异均无统计学意义(P>0.05);治疗3、7 d,A、B、C组血清BNP、CK-MB、MDA、TG水平较对照组降低,GSH-Px水平、LVEF较对照组升高(P<0.05);治疗3、7 d,B、C组血清BNP、CK-MB、MDA、TG水平较A组降低,GSH-Px水平、LVEF较A组升高(P<0.05).4组患儿治疗3 d较治疗前血清BNP水平下降百分比比较,差异有统计学意义(P<0.05);其中A、B、C组较对照组升高(P<0.05).结论 左卡尼汀治疗并发BNP水平异常的重症感染致心力衰竭患儿有较好的心脏保护作用,可显著改善患儿BNP、CK-MB、MDA、GSH-Px、TG水平及心功能.
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