心率变异多参数定量及回归分析在鉴别儿童心电图ST-T改变性质中的辅助诊断价值  

Differential diagnosis value of HRV quantitive and regression analyses in children with ST-T changes in electrocardiogram

作　　者：宋安齐[1] 牛小麟[1] 张超英[1] 杜颖[1] 郭润梅[1] 

机构地区：[1]西安交通大学第二医院心内科,陕西西安710004

出　　处：《第四军医大学学报》2006年第12期1127-1129,共3页Journal of the Fourth Military Medical University

摘　　要：目的:探讨心率变异(HRV)对于儿童心电图ST-T改变鉴别诊断的意义.方法:对40例单纯ST-T改变患儿、41例伴ST-T改变病毒性心肌炎患儿、40例正常儿童行24h动态心电图分析,观察HRV时域、频域十项参数24h及清醒期和睡眠期的改变.以ST压低值为因变量,24h,清醒期、睡眠期的全部HRV频域、时域参数为自变量进行多元相关回归分析.结果:单纯ST-T改变患儿睡眠期HRV升高,高频带(HF)1465±197vs497±201(P<0.017),昼夜波动增大,伴ST-T改变心肌炎患儿HRV持续降低.总功率谱密度(TP)2647±1328vs3121±569(P<0.017),HF305±199vs667±116(P<0.017)昼夜波动消失.多元回归分析显示HF/LF和极低频带(VLF)分别与单纯ST-T改变组和心肌炎组的ST压低关系密切.结论:提出了有助于鉴别儿童ST-T改变性质的HRV特征及HRV辅助诊断指标.AIM： To study the value of heart tate variability （HRV） analysis in distinguishing the child ren with ST-T changes in electrocardiogram （ECG）. METHODS： In 121 children （40 cases of simple ST-T changes, 40 of viral myocarditis with ST-T changes and 40 normal children）, 24 h Holter monitoring were conducted and all HRV parameters （ including time domain and frequency domain） were analyzed, and the ECG changes during waking and sleeping periods was observed. With ST depression as dependent variables, all HRV parameters as independent variables ,multiple regression analysis was carried out. RESULTS： In the pure ST-T change group, HRV was increased, HF being 1465 ± 197 vs 497± 2201 （P 〈 0.017） ; the alteration between sleeping and waking periods was more obvious as compared with normal group. In ST-T changes plus viral myocarditis group, HRV was decreased continuously, TP being 2647 ± 1328 vs 3121 2569 （P 〈0.017）, and HF being 305 ± 199 vs 667 ± 116 （P 〈0.017） ; the alteration between sleeping and waking periods was significantly diminished. Multiple regression analysis showed ST-T depression in pure group was correlated with HF/LF, VLF, pNN50N and SDNNN; in myocarditis group, ST-T depression was correlated with VLF, LFN and LF. CONCLUSION： Specific HRV changes were found both in pure ST-T changes and viral myocardi- tis plus ST-T changes group. There were several useful parameters in distinguishing functional and organic ST-T changes in children.

关 键 词：心率变异性 ST-T改变 回归分析 自主神经系统 儿童 

分 类 号：R540.4[医药卫生—心血管疾病]