心肌炎儿童的长程心率变异改变及其与心脏大小和功能的相关性  

Changes of heart rate variability and its relationship to cardiac size and function in children with myocarditis

作　　者：靳有鹏[1] 邓新[2] 王玉林[1] 韩波[1] 汪翼[1] 韩秀珍[1] 马沛然[1] 

机构地区：[1]山东大学附属省立医院儿科,济南250021 [2]山东大学附属省立医院动态心电图室,济南250021

出　　处：《山东大学学报（医学版）》2008年第10期971-973,共3页Journal of Shandong University:Health Sciences

基　　金：山东省卫生厅立项课题(99CA1DBA1)

摘　　要：目的研究心肌炎患儿的长程心率变异(HRV)改变及其与心脏大小和功能的相关性。方法对100例心肌炎患儿(心肌炎组)和50例健康儿童(对照组)分别行24 h心率变异分析,得出连续平均正常R-R间期标准差(SDNN),每5 min R-R间期平均值的标准差(SDANN),每5 min正常R-R间期标准差的平均值(SDNN index),相邻正常R-R间期差值的均方根值(rMSSD),相邻R-R间期之差大于50ms的心搏次数占总心搏次数的百分比(PNN50),总功率TP(0-0.4Hz),低频成分LF(0.04-0.15Hz),高频成分HF(0.15-0.4Hz)及LF/HF等指标。并空腹测定肌酸激酶同工酶(CKMB)和肌钙蛋白I(cTnI),同时接受经胸超声心动图检查,取得左房舒张末期前后径(LAED)、左室舒张末期前后径(LVED)、左室射血分数(LVEF)和短轴缩短率(LVFS)等指标。对两组的上述指标进行比较,并分析心肌炎患儿的心率变异性与心脏大小和功能的相关性。结果与对照组相比,心肌炎组的SDNNr、MSSD、PNN50、HF显著降低(P均<0.05),SDANN、SDNN index、TP、LF略降低(P均>0.05);心肌炎患儿CKMB显著增高(P<0.01),cTnI和LAED明显增高(P均<0.05);心肌炎组的SDNN与LAED、LVEF呈中等相关(r=-0.52,r=0.49,P均<0.05),其余HRV指标与心肌酶、肌钙蛋白、心脏大小及心功能无明显相关。结论心肌炎患儿的HRV普遍降低,提示自主神经系统的总体功能受损,以迷走神经张力降低为主,交感神经张力相对增强,部分HRV指标与心脏大小及心功能有一定的相关性,部分HRV指标是相对独立的,将HRV指标与常规测量指标结合起来能更好的指导心肌炎的诊断和预后的判断。Objective To investigate the changes of heart rate variability （HRV） and its relationship to cardiac size and function in children with myocarditis. Methods 100 children with myocarditis served as the experimental group and 50 normal children as the control group. All received holter ECG and color Doppler echocardiography examination, and the levels of serum creatine phosphokinase MB and troponin I were quantitatively determined. The 24-hour HRV parameters included SDNN, SDANN, rMSSD, PNN50, LF, HF and LF/HF. Echocardiography parameters included end-diastolic diameter of left atrial （LAED）, enddiastolic diameter of left ventricle （LVED）, left ventricular ejection fraction （LVEF） and fractional shorting （LVFS）. Linear regression was used to analyze the relationship between HRV and Echocardiography parameters. Results In the experimental group, LF/HF, CKMB, cTnl and LAED were significantly higher（ P 〈 0.05） while SDNN, rMSSD, PNN50 and HF were significantly lower （ P 〈 0.05） compared with the control group. SDNN was moderately correlated with LAED（ r = - 0.52, P 〈 0. 05） and LVEF（ r = 0.49, P 〈 0.05）. Conclusions In children with myocarditis, both the vagal and sympathetic nerve are impaired. Some HRV parameters are correlated with abnormality of cardiac structure and function, while others are independent. Further study is needed to investigate the prognostic value of HRV in children with myocarditis.

关 键 词：心肌炎 心率变异 心脏大小 心脏功能 儿童 

分 类 号：R725.4[医药卫生—儿科]