24 h动态心电图心率变异性指标对儿童病毒性心肌炎预后的预测效能  

The effectiveness of 24-hour dynamic electrocardiogram heart rate variability indicators for the prediction of the prognosis of viral myocarditis in children

作　　者：杜沛 李晓敏 DU Pei;LI Xiaomin(Department of Function,Northwest Women′s and Children′s Hospital,Xi′an 710061,Shaanxi Province,China)

机构地区：[1]西北妇女儿童医院功能科,陕西西安710061

出　　处：《新乡医学院学报》2025年第3期225-230,共6页Journal of Xinxiang Medical University

摘　　要：目的探讨24 h动态心电图心率变异性(HRV)指标对儿童病毒性心肌炎预后的预测效能。方法选择2020年1月至2023年6月西北妇女儿童医院收治的135例病毒性心肌炎患儿为研究对象。根据治疗30 d预后不同分为预后良好组(n=105)和预后不良组(n=30)。收集2组患儿临床资料(包括性别、年龄、感染病毒类型、有无呼吸道感染、有无消化道感染、ST-T改变、是否心动过速)、HRV指标[正常窦性心律RR间期的标准差(SDNN)、相邻RR间期差值>50 ms的个数占RR间期总数的百分比(PNN50)、每5 min RR间期标准差(SDANN)、全程相邻RR间期差值的均方根(RMSSD)、高频功率(HF)、低频功率(LF)]。应用全自动生化分析仪检测2组患儿心肌损伤标志物[心肌肌钙蛋白I(cTnI)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)]水平。比较2组患儿临床资料、HRV指标及心肌损伤标志物水平。采用Pearson相关分析HRV指标与心肌损伤标志物相关性;采用logistic回归分析HRV指标与病毒性心肌炎患儿预后的关系,绘制受试者操作特征(ROC)曲线分析HRV指标对病毒性心肌炎患儿预后预测价值。结果2组患儿性别、年龄、感染病毒类型、合并呼吸道感染、合并消化道感染比例比较差异无统计学意义(P>0.05);预后不良组患儿ST-T改变、心动过速比例、LDH、CK、CK-MB、cTnI水平显著高于预后良好组(P<0.05);预后不良组患儿SDNN、SDANN、PNN50、RMSSD、LF、HF显著低于预后良好组(P<0.05)。Pearson相关性分析显示,SDNN、SDANN、PNN50、RMSSD、LF、HF与LDH、CK、CK-MB、cTnI呈负相关(P<0.05)。logistic回归分析显示,SDNN、SDANN、PNN50、RMSSD、LF、HF是病毒性心肌炎患儿预后的独立影响因素(P<0.05)。以预后不良组作为阳性样本,预后良好组作为阴性样本,ROC曲线分析结果显示,SDNN、SDANN、PNN50、RMSSD、LF、HF预测病毒性心肌炎患儿预后的曲线下面积(AUC)分别为0.748(95%置信区�Objective To explore the effectiveness of 24-hour dynamic electrocardiogram heart rate variability(HRV)indicators for the prediction of the prognosis of viral myocarditis in children.Methods A total of 135 children with viral myocarditis admitted to Northwest Women′s and Children′s Hospital from January 2020 to June 2023 were selected and then divided into a good prognosis group(n=105)and a poor prognosis group(n=30)according to the prognosis after 30 days of treatment.Clinical data(including gender,age,virus type,respiratory and digestive tract infections,ST-T changes,and tachycardia)and HRV indicators[including the standard deviation of all normal to normal RR intervals(SDNN),percentage of difference between adjacent RR intervals>50 ms(PNN50),standard deviation of all 5-minute RR intervals(SDANN),the root mean square of successive differences of RR intervals(RMSSD),high frequency power(HF),and low frequency power(LF)]were collected from the two groups of patients.An automatic chemistry analyzer was used to detect the levels of myocardial injury markers[cardiac troponin I(cTnI),lactate dehydrogenase(LDH),creatine kinase(CK),and creatine kinase-MB(CK-MB)].The clinical data,HRV indicators and myocardial injury markers were compared between the two groups.Pearson correlation analysis was made to analyze the relationship between HRV indicators and myocardial injury markers.Logistic regression analysis was used to analyze the relationship between HRV indicators and the prognosis of children with viral myocarditis.The value of HRV indicators for predicting the prognosis of children with viral myocarditis was analyzed using the receiver operating characteristic(ROC)curve.Results There was no significant difference in gender,age,virus type,combined respiratory and digestive tract infection rates between the two groups of children(P>0.05).The proportions of patients with ST-T changes and tachycardia and the levels of LDH,CK,CK-MB,and cTnI in the poor prognosis group were significantly higher than those in the good pr

关 键 词：病毒性心肌炎 动态心电图 心率变异性 心肌损伤标志物 

分 类 号：R542.2[医药卫生—心血管疾病] R725.4[医药卫生—内科学]