摘要
目的探讨血管迷走性晕厥(VVS)患儿静息状态下心率减速力(DC)和心率变异性(HRV)参数变化的规律,评估VVS患儿基础自主神经功能状态,进一步探讨DC用于儿童VVS诊断的参考价值.方法选取2015年6月至2017年12月首都儿科研究所附属儿童医院确诊的62例VVS患儿为VVS组,同时期门诊体检后确定的健康儿童56例作为健康对照组,完善24 h动态心电图检查,按年龄段或性别进行分层,比较健康儿童及VVS患儿DC及HRV指标.结果 1. DC及HRV参数随年龄及性别的变化规律:无论在健康儿童还是VVS患儿,DC及HRV参数在青春期较学龄期有显著变化,按性别分组男女DC值及HRV各项参数差异均无统计学意义.2. VVS组及健康对照组在学龄期及青春期DC和HRV的比较:在学龄期,VVS组患儿DC值[(6. 8 ± 1. 0)ms]明显高于健康对照组儿童[(6. 0 ± 0. 7)ms],差异有统计学意义(t=-2. 412,P<0. 01),HRV参数相邻RR间期差值的均方根(rMSSD)显著升高(P<0. 05);在青春期,VVS组患儿DC值[(7. 4 ± 1. 2)ms]较健康对照组[(6. 6 ± 1. 1)ms]显著升高,差异有统计学意义( t=-2. 742,P<0. 01);HRV参数rMSSD及低频功率(LF)、高频功率(HF)均明显高于健康对照组,差异均有统计学意义(均P<0. 05).3. DC对VVS 诊断的参考价值:分别在学龄期及青春期以DC、HRV相关指标为自变量进行Logistic回归分析,发现仅DC与VVS相关;采用受试者工作特征曲线分析DC对VVS的预测价值,发现学龄期以DC 6. 5 ms作为界值,青春期以DC 7. 0 ms作为界值时,具有较高的灵敏度及特异度.结论儿童自主神经功能随年龄增长发生变化,青春期DC及HRV参数较学龄期有显著变化;VVS患儿存在异常增高的心脏副交感神经张力;学龄期儿童DC≥6. 5 ms,青春期儿童DC≥7. 0 ms时,对VVS的诊断可能具有一定的预测价值.
Objective To investigate the changes in heart rate deceleration capacity( DC)and heart rate va-riability(HRV)parameters in children with vasovagal syncope(VVS),to assess the basic autonomic function of children with VVS,and to explore the reference value of DC for the diagnosis of VVS in children. Methods VVS group included 62 patients diagnosed with VVS in the Cardiovascular Department of Children's Hospital Affiliated to Capital Institute of Pediatrics from June 2015 to December 2017,56 outpatients undergoing physical examination were selected as the healthy control group,and the changes in DC and HRV matched to age and gender were analyzed respectively. Indexes of DC and HRV of both groups of children in health control group and children with VVS were compared among different age groups or different genders. Results (1)Analysis of DC and HRV based on age or gender:whether in healthy children or in children with VVS,DC and HRV parameters varied significantly in the range of different ages,while they were the same in children with different genders.(2)Comparison of DC and HRV in school-age and puberty children between VVS group and healthy control group:in school-aged children,DC of VVS group was significantly higher than that of healthy control group[(6. 8 ± 1. 0)ms υs.(6. 0 ± 0. 7)ms,t=-2. 412,P<0. 01]. Mean square root rates of succe-ssive normal sinus RR interval differences(rMSSD)increased,and the difference was significant( P<0. 05). In chil-dren at puberty,DC in children of VVS group was significantly higher than that in the healthy control group[(7. 4 ± 1. 2)ms υs.(6. 6 ± 1. 1)ms,t=-2. 742,P<0. 01],rMSSD,LF and HF value were significantly higher compared with those of the healthy control group(all P<0. 05).(3)Predictive value of DC on VVS:the binary Logistic regression analysis found that only DC was associated with VVS in different age groups. By using receiver operating characteristic curve to analyze the predictive value of DC on VVS,it was found that when making DC 6. 5 ms for school age and 7.
作者
张静
郑彤
林瑶
刘杨
石琳
Zhang Jing;Zheng Tong;Lin Yao;Liu Yang;Shi Lin(Department of Cardiology,Children′s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2019年第13期986-989,共4页
Chinese Journal of Applied Clinical Pediatrics
关键词
血管迷走性晕厥
心率减速力
心率变异性
自主神经功能
Vasovagal syncope
Deceleration capacity
Heart rate variability
Autonomic nervous function
