心率血压乘积对儿童体位性心动过速综合征预后的估测价值  

Prognostic value of rate-pressure product in children with postural tachycardia syndrome

作　　者：王硕[1,2,3] 蔡虹 丁异熠[3] 谭传梅[2] 秧茂盛 王玉汶[1] 邹润梅 许毅[1] 王成[1] Wang Shuo;Cai Hong;Ding Yiyi;Tan Chuanmei;Yang Maosheng;Wang Yuwen;Zou Runmei;Xu Yi;Wang Cheng(Department of Pediatric Cardiovasology,Children′s Medical Center,the Second Xiangya Hospital,Central South University/Institute of Pediatrics,Central South University,Changsha 410011,China;Jishou University School of Medicine,Jishou 416000,Hunan Province,China;Department of Pediatrics,the First People′s Hospital of Changde,Changde 415000,Hunan Province,China)

机构地区：[1]中南大学湘雅二医院儿童医学中心儿童心血管专科,湖南长沙410011 [2]吉首大学医学院,湖南吉首416000 [3]常德市第一人民医院儿科,湖南常德415000

出　　处：《中华实用儿科临床杂志》2020年第13期969-973,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨心率血压乘积(RPP)对儿童体位性心动过速综合征(POTS)预后的估测价值。方法收集2012年4月至2019年5月因不明原因晕厥或晕厥先兆在中南大学湘雅二医院儿童晕厥专科门诊就诊,并通过直立倾斜试验(HUTT)诊断为POTS的5~15岁儿童53例(男26例,女27例)(POTS组)。匹配同期在中南大学湘雅二医院儿童保健专科门诊进行健康检查的5~16岁健康儿童38例(男19例,女19例)为对照(对照组)。对POTS儿童进行干预后随访,根据随访结果分为干预有反应组(40例)和干预无反应组(13例)。计算各组儿童基线(HUTT 0 min)、HUTT 5 min、HUTT 10 min的心率(HR0、HR5、HR10)与对应时间点收缩压(SBP0、SBP5、SBP10)的乘积(RPP0、RPP5、RPP10)。应用SPSS 22.0软件及EmpowerStats软件进行统计分析。结果1.人口学特征:POTS组与对照组年龄、性别比较差异均无统计学意义(均P>0.05)。2.POTS组HR5[(115.45±14.50)次/min比(95.79±13.89)次/min]、HR10[(120.57±16.13)次/min比(96.05±12.43)次/min]、RPP5(12814.55±2304.56比10371.42±1910.20)及RPP10(13449.17±2360.40比10523.18±1771.48)均明显高于对照组,差异均有统计学意义(t=0.799、7.842、5.747、6.446,均P<0.01)。2组间HR0和RPP0比较差异均无统计学意义(均P>0.05)。3.POTS组中有反应组HR5[(98.73±12.43)次/min比(113.77±17.65)次/min]和HR10[(96.90±13.96)次/min比(119.08±13.52)次/min]、RPP5(11125.45±1952.35比12914.69±3192.12)及RPP10(10819.58±2144.26比13375.46±2807.01)均明显低于无反应组,差异均有统计学意义(t=3.406、5.012、2.432、3.455,均P<0.01)。2组间HR0和RPP0比较差异均无统计学意义(均P>0.05)。4.阈值效应:当SBP10<114 mmHg(1 mmHg=0.133 kPa)时,SBP10每增加1 mmHg,POTS干预后有反应的概率增加10%,二者有相关关系(P<0.05)。5.受试者工作特征(ROC)曲线分析:RPP5为11548.50时,预测POTS干预后有反应的敏感度为81.82%,特异度为61.70%。RPP10为10988.00时,预测POTS干预后有反应的敏感度为77.78Objective To investigate the value of rate-pressure product(RPP)in predicating the prognosis of postural tachycardia syndrome(POTS)in children.Methods Fifty-three children(26 males and 27 females)aged 5 to 15 who had syncope of unknown reasons or presyncope and were diagnosed with POTS by head-up tilt test(HUTT)at the Children′s Syncope Specialist Clinic,the Second Xiangya Hospital,Central South University from April 2012 to May 2019 were selected as the POTS group.Thirty-eight children aged 5 to 16(19 males and 19 females)who underwent medical examinations at the Children′s Health Specialist Clinic of the Second Xiangya Hospital,Central South University over the same period were enrolled as controls(control group).POTS children were followed up after intervention and they were divided into the response group(n=40)and the non-response group(n=13)according to the follow-up results.The products(RPP0,RPP5,RPP10)of the heart rate(HR0,HR5,HR10)and systolic blood pressure(SBP0,SBP5,SBP10)at baseline(HUTT 0 min),HUTT 5 min and HUTT 10 min were calculated.Statistical analysis was performed using SPSS 22.0 software and EmpowerStats software.Results(1)There was no statistical difference in age and gender between the POTS group and the control group(all P>0.05).(2)HR5[(115.45±14.50)times/min vs.(95.79±13.89)times/min],HR10[(120.57±16.13)times/min vs.(96.05±12.43)times/min],RPP5(12814.55±2304.56 vs.10371.42±1910.20),and RPP10(13449.17±2360.40 vs.10523.18±1771.48)in the POTS group were significantly higher than those in the control group(t=0.799,7.842,5.747,6.446,all P<0.01).No statistical difference of HR0 and RPP0 was observed between the 2 groups(all P>0.05).(3)In the POTS group:HR5[(98.73±12.43)times/min vs.(113.77±17.65)times/min],HR10[(96.90±13.96)times/min vs.(119.08±13.52)times/min],RPP5(11125.45±1952.35 vs.12914.69±3192.12)and RPP10(10819.58±2144.26 vs.13375.46±2807.01)in the response group were significantly lower than those in the non-response group(t=3.406,5.012,2.432,3.455,all P<0.01).HR0 and

关 键 词：体位性心动过速综合征 心率血压乘积 预后 儿童 

分 类 号：R725.4[医药卫生—儿科]