病毒唑治疗肾综合征出血热对肌酸磷酸激酸同工酶的影响

1、    病毒唑治疗肾综合征出血热对肌酸磷酸激酸同工酶的影响        【摘要】目的探讨治疗肾综合征出血热(HFRS)时，病毒唑(Ribavirin)对肌酸磷酸激酶同工酶(CK-MB)的影响。方法对155例肾HFRS患者在进行较大剂量Ribavirin双盲随机对照治疗中对血清CK-MB进行了动态观察，并将HFRS各期、各型病毒唑治疗组与对照组CK-MB水平进行了比较。结果两组病例从发热期开始CK-MB明显升高，恢复期时逐渐恢复正常，病毒唑组发热期CK-MB明显低于对照组，分

2、别为55.25±18.25U/L和69.63±23.52U/L(P<0.05)；重、危型病毒唑组CK-MB明显低于对照组，分别为47.74±24.82U/L和66.08±25.01U/L(P<0.05)。结论较大剂量病毒唑的早期应用可使HFRS患者血清中CK-MB浓度下降。【主题词】病毒唑肌酸磷酸激酶同工酶肾综合征出血热 The treatment effect of ribavirin to hemorrhagic fever with renal syndrom on the kinetics of serum creatine phos

3、phate kinase isoenzymeZHANG Quanrong, TANG Rongfu, YUAN Guanghui, et al.(The First Affiliated Hospital of Hubei Medical University, Wuhan 430060)【Abstract】ObjectiveTo study the effect of ribavirin treatment on kinetics of serum creatine phosphate kinase isoenzyme(CK-MB) of patients with hemoarrhagic

4、 fever with renal syndrome(HFRS).MethodsCK-MB levels in 155 HFRS patients treated with larger dose of ribavirin and with routine therapeutic dose were observed dynamicaly, using randomly controlled double-blind method. In addition, CK-MB levels in different disease phases and different clinical type

5、s of HFRS were compared.ResultsThe results showed that CK-MB levels were significantly increased in febrile phase and decreased gradually to normal during convalescent phase in both groups, but in febrile phase, CK-MB levels in ribavirin-treated group and control group were 55.25±18.25IU/L and

6、69.63±23.52IU/L, respectively, the treated group had a lower level (P<0.05). The severe and critical group treated by ribavirin showed a lower CK-MB level of 47.74±24.82IU/L, while the control group showed a higher level of 66.08±25.01IU/L(P<0.05).ConclusionThese results indicat

7、ed that an early application of large dose of ribavirin in treatment of HFRS can reduce the serum CK-MB levels in patients with HFRS.【Key words】RibavirinCreatin phosphate kinase isoenzymeHemorrhagic fever with renal syndrome(HFRS)肾综合征出血热(HFRS)时心肌常严重损害，早期阻断或减轻HFRS病毒对心肌损害并可减少心脏并发症，因此我们对155例HFRS患者进行较大剂

8、量病毒唑双盲随机对照治疗并对血清肌酸磷酸激酶同工酶(CK-MB)进行了动态观察，现将观察结果报道如下。1材料和方法1.1研究对象155例HFRS患者均为住院病例，按1986年南京全国HFRS学术会议所制定的标准进行诊断、分型，临床诊断必须为早期特异性IgM检查所确诊。分型中病毒唑组轻型15例、中型46例、重型16例、危重型2例；对照组轻型16例、中型45例、重型8例、危重型7例，为便于统计，将轻型与中型合并为轻、中型，重型与危重型合并为重、危型，现将两组病例的一般情况列于表1。表1两组病例均衡性检验Tab.1The general conditions of two groups of HFR

9、S patients项目Item病毒唑组Ribavirin treated of group对照组Control groupP例数(例)Cases7976>0.05治疗前平均病程(天)Average course of disease before treatment (day)4.22±1.174.24±1.25>0.05平均年龄(岁)Average age(year)32.09±12.7734.60±12.39>0.05男女(例)Malefemale(Cases)63165917>0.05   &

10、#160; 1.2药物剂量病毒唑为Eastmak kodak公司产品，为无热原性静脉注射剂。对照组为用于溶解病毒唑的磷酸缓冲液。药物与对照液均为密码编号，按体重给药。第14 d为每6 h 16 mg/kg，首次剂量加倍，第57 d每8 h 8 mg/kg,每次以50 ml生理盐水静脉滴注，时间不得少于30 min、疗程为7 d。1.3仪器、试剂与方法应用美国Abbott公司的程序自控双波长生化分析仪检测CK-MB，所用试剂也为该公司产品。入院当天，用药前采集静脉血1次，然后每隔1 d采血1次。本仪器测定CK-MB的方法为免疫法。1.4统计学处理本研究资料近似正态分布，采用算术均数和标准差描述，

11、推断采用t检验。 2结果2.1HFRS各期CK-MB水平的比较(IV/2)见表2。表2两组各期CK-MB水平比较(IU/L)Tab.2Comparison of CK-MB levels in different disease phases of two groups组别Group发热期Febrile phase低血压期Low blood pressure phase少尿期Oligurea phase多尿期Polyurea phase恢复期Convalescent phasen<"xx1 (881 bytes)" src="/med/cano/201003

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13、/20100319195624859" 12 14>±sn<"xx1 (881 bytes)" src="/med/cano/201003/20100319195624859" 12 14>±s病毒唑组Ribavirin group3755.25±18.25*454.25±12.27443.88±12.466339.02±14.172932.80±11.75对照组 Control group3869.03±23.52360.33±18.1

14、5855.66±17.097440.77±14.633733.20±13.24     n:标本数*与对照组相比 P<0.05n:No.specimens*:P<0.05, as compared with the control2.2HFRS各型CK-MB水平比较(IU/L)见表3。表3两组各型CK-MB水平比较(IU/L)Tab.3Conparison of CK-MB levels in different clinical types of two groups组别Group轻、中型Mild modera

15、te typeP重、危型Severe critical typePn<"xx1 (881 bytes)" src="/med/cano/201003/20100319195624859" 12 14>±sn<"xx1 (881 bytes)" src="/med/cano/201003/20100319195624859" 12 14>±s病毒唑组Ribavirin group15034.42±21.804447.74±24.82*>0.05&l

16、t;0.05对照组Control group13537.39±19.883866.08±25.01     n：标本数*与对照组相比P<0.05n：No.specimens* P<0.05, as compared with the comtrol3讨论我们对155例HFRS患者进行较大剂量病毒唑双盲随机对照治疗时，对血清CK-MB进行了动态观察，发现两组病例从发热期开始CK-MB即明显升高，恢复期时逐渐恢复正常。HFRS发热期患者有病毒血症存在1，可能由于HFRS病毒作为始动因子对心肌细胞造成了损伤，使细胞中CK-MB释放于血中，致使血清中CK-MB从发热期即开始升高，恢复期随着病毒血症消失而逐渐恢复正常，这与文献报道2出血热患者心电的异常以发热期为最高是一致的。病毒唑是人工合成的广谱抗病毒药物，早期使用病毒唑能抑制病毒复制3，4，能够显著减少或减轻出血热患者心脏损害，减少发生严重心脏并