关键词: 手足口病, 心肺功能衰竭, 左卡尼汀, 心肌酶异常, 心功能异常, 治疗结果

Abstract: Background　Hand，foot and mouth disease（HFMD）is a acute infectious disease in children.Severe HFMD is mostly caused by Enterovirus 71 （EV71）．Some patients with severe HFMD face short-term cardiopulmonary failure or even death.It is not clear whether levocarnitine，as the cardioprotection therapy，can improve the prognosis of patients with abnormal cardiac function and myocardial enzymes before cardiopulmonary failure.Objective　To evaluate cardiac function and the levels of myocardial enzyme before and after treatment in critically ill children at the early stage of cardiopulmonary failure with HFMD infected by EV71，and to explore the efficacy of adjuvant therapy with levocarnitine on myocardial injury and cardiac dysfunction and improvement of clinical prognosis and outcomes.Methods　A total of 120 critically ill HFMD patients infected by EV71 admitted to Children's Hospital Affiliated of Zhengzhou University from April 2016 to September 2017 were enrolled and randomly divided into conventional group （n=60） and levocarnitine group （n=60）．All patients were given the conventional therapy as the basic treatment，and subjects in levocarnitine group were treated with additional levocarnitine injection as adjuvant therapy.The levels of blood creatine kinase （CK），creatine kinase isoenzyme （CK-MB） and troponin T （cTnT），brain natriuretic peptide （BNP），N-terminal pro-brain natriuretic peptide （NT-proBNP）were measured before and 24 hours after treatment in two groups.Left ventricular ejection fraction （LVEF），left ventricular fractional shortening （FS） and cardiac index （CI） were measured by three-dimensional echocardiography.The curative effect was determined on the seventh day of treatment，and the occurrence of complications was recorded．Results　Of the 120 cases，57 （47.5%） had abnormal CK，70 （58.3%） had abnormal CK-MB，40 （33.3%） had abnormal cTnT，75 （62.5%） had abnormal BNP，81 （67.5%） had abnormal NT-proBNP，61 （50.8%） had abnormal LVEF，and 53 （44.2%） had abnormal FS.There was no significant difference in the abnormal rates of CK，CK-MB，cTnT，BNP，NT-proBNP，LVEF and FS between the two groups （P>0.05）．After the treatment，the levels of blood CK，CK-MB，cTnT，BNP and NT-proBNP in levocarnitine group were significantly lower than those in conventional group；CK level in conventional group was lower than that before treatment （P<0.05）；levels of CK，CK-MB，cTnT，BNP，NT-proBNP in levocarnitine group were lower than those before treatment （P<0.05）；LVEF，FS and CI in levocarnitine group were higher than those in conventional group （P<0.05）．LVEF，FS and CI after the treatment in two groups were all higher than those before treatment （P<0.05）．After the treatment，the clinical efficacy of levocarnitine group was better than that of conventional group （Z=-2.317，P=0.013）．The incidence of pulmonary edema and pulmonary hemorrhage in levocarnitine group was lower than that in conventional group （P<0.05）．Conclusion　Abnormal heart function and abnormal levels of myocardial enzyme are found in critically ill children at the early stage of cardiopulmonary failure with HFMD infected by EV71.Levocarnitine can improve clinical efficacy，prognosis and outcome by effectively improving myocardial cells and cardiac function in short-term.

Key words: Hand, foot and mouth disease；Cardiopulmonary failure；Levocarnitine；Abnormal myocardial enzymes；Abnormal cardiac function；Treatment outcome