摘要
目的:探讨病毒性心肌炎(VMC)并发心律失常合理用药治疗方案。方法:住院VMS患者290例,对患者病史、诊治过程及治疗结果进行回顾性分析。结果:出现心律失常患者共有273例,其中以室性期前收缩最多见,共142例(49.0%),其次为房性期前收缩73例(25.2%);病毒检测为阳性患者共249例(85.9%);血清抗心肌抗体检测为阳性患者共152例(52.4%),其中最常见为抗β1-受体抗体53例(34.9%),其次为抗腺嘌呤核苷酸转位酶抗体50例(32.9%)。病毒阳性与抗心肌抗体阳性之间具有相关性,两者均与心律失常的发生相关联。黄芪治疗心律失常改善率为54.35%,明显高于未用黄芪组21.43%(P<0.01);黄芪与美托洛尔联合治疗心律失常改善率为76.25%,明显高于未用黄芪组和单用黄芪治疗组(P<0.01);黄芪与胺碘酮合用治疗心律失常改善率为87.63%。结论:病毒感染及自身免疫是VMC并发心律失常的主要致病因素,黄芪具有明显的抗病毒和免疫调节作用,能在一定程度上改善心肌炎所致心律失常;美托洛尔与其合用后能明显减少和抑制心律失常的发生;对于恶性室性心律失常者,胺碘酮与黄芪合用更有效。
Objective：To explore the different drug therapies available for the treatment of arrhythmias in patients with virus myocarditis （VMC）. Method： A retrospective study of 290 patients hospitalized for VMC between January 2001 and December 2005 was performed in Union Hospital, Wuhan, China. The evaluation included medical history and results of the follow-up. Result：Arrhythmias were observed in 273/290 patients： ventricular premature beat was seen in 142 patients （49.0%）, and atrial premature beat in 73 patients （25.2%）. Viral infection was positive in 249 patients（85.9%）. Anti-heart antibody （AHA） was positive in 152 patients（52.4%）, also positive were the β1-agrenoceptor antibody （34.9 % ） and antibody against adenine nucleotide translocator （ANT） （33 %）. Both viral infection and AHA were related to the occurrence of arrhythmias. Cases treated with radix astragali showed higher success rates （54.35 % ） than those with no radix astragali （21.43 % ） （P〈0. 01 ）, and cases treated with radix astragali in combination with metoprolol also showed higher success rates （76.25 %） than the former two groups （P〈0.01）. Combined use of radix astragali and amiodarone its success rate was 87.63%. Conclusion：Virus / autoimmunity was an important link in the pathogenesis of viral myocarditis. Radix astragali was a potent antiviral agent, and could improve arrhythmias in patients with VMC. However, metoprolol in combination with radix astragali might has a better therapeutic effect on recurrence of arrhythmias than radix astragali alone. Combination of radix amiodarone and astragali showed better effect in treating severe arrhythmias which did not respond to other regiments.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2008年第1期18-20,共3页
Journal of Clinical Cardiology
