临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (9): 665-.doi: 10.3969/j.issn.1000-3606.2020.09.007

• 综合报道 • 上一篇    

血管迷走性晕厥患儿无症状期自主神经功能分析

童可, 何爽, 明黎, 朱琳, 余更生   

  1. 重庆医科大学附属儿童医院心血管内科 儿童发育疾病研究教育部重点实验室 国家儿童健康与 疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市 重点实验室(重庆 400014)
  • 发布日期:2020-09-17
  • 通讯作者: 余更生 电子信箱:yugengsheng@163.com

Analysis of autonomic nervous function in asymptomatic vasovagal syncope in children

 TONG Ke, HE Shuang, MING Li, ZHU Lin, YU Gengsheng   

  1. Department of Cardiovascular Disease, Children’s Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
  • Published:2020-09-17

摘要: 目的 分析无症状期心率减速力(DC)对血管迷走性晕厥(VVS)的诊断价值。方法 选取2018年1月至 2019年12月确诊为VVS的45例患儿作为VVS组,同期在门诊体检的45例健康儿童作为对照组,完善24小时动态心电 图检查,比较VVS患儿和健康儿童的基础DC值、连续心率减速力(DRs)及心率变异性(HRV)各指标的变化情况,并按 年龄段及性别进行分组比较;同时分析DC与HRV各指标间的相关性及DC对VVS诊断的预测价值。结果 VVS组的 DC值、DR8及低频功率与高频功率之比(LF/HF)均明显高于对照组,差异均有统计学意义(P<0.05)。 在VVS组中,学 龄期患儿的DC值、DR4及低频功率(LF)均明显低于青春期患儿,差异均有统计学意义(P<0.05),而男女患儿的DC值、 DRs、HRV各指标差异均无统计学意义(P>0.05)。 对照组年龄段及性别组间DC值、DRs、HRV各指标差异均无统计学意 义(P>0.05)。 学龄期VVS组的DC值明显高于对照组,青春期VVS组的DC值、DR4、DR8及LF均明显高于对照组,差异 有统计学意义(P<0.05)。DC与HRV多项指标呈显著正相关(r=0.31~0.67, P均<0.05),与LF/HF呈显著负相关(r= -0.36, P<0.05)。行二分类logistic回归分析发现,青春期患儿仅DC与VVS相关(P<0.05)。采用受试者工作特征曲线(ROC) 分析发现,学龄期DC值以7.72 ms、青春期DC值以8.36 ms为界值时有较好的灵敏度及特异度。结论 VVS患儿无症状 期自主神经功能存在异常,随年龄增长,自主神经功能异常更加显著。学龄期及青春期VVS患儿均有迷走神经张力升高, 且青春期VVS患儿还有一定程度交感神经张力升高;DC与迷走神经张力间呈明显正相关,对VVS诊断有较好预测价值。

关键词: 血管迷走性晕厥; 心率减速力; 连续心率减速力; 心率变异性; 自主神经功能

Abstract: Objective To explore the diagnostic value of heart rate deceleration (DC) in asymptomatic vasovagal syncope (VVS). Methods Forty-five children diagnosed with VVS from January 2018 to December 2019 were selected as the VVS group, and 45 healthy children who underwent outpatient physical examination during the same period were selected as the control group. The 24h dynamic electrocardiogram was performed. The changes of baseline DC value, heart rate deceleration runs (DRs) and heart rate variability (HRV) between VVS and healthy children were compared, and the above indicators were compared by age and gender groups. At the same time, the correlation between DC and HRV related-indicators, and the predictive value of DC for VVS diagnosis were analyzed. Results The DC value, DR8, and the ratio of low frequency power to high frequency power (LF/HF) in the VVS group were significantly higher than those in the control group, and the differences were statistically significant (P<0.05). In VVS group, DC value, DR4 and LF of school-age children were significantly lower than those of adolescent children (P<0.05). However, there was no statistically significant difference in DC value, DRs and HRV indexes between male and female children (P>0.05). The control group was divided into groups by age and gender, and there were no statistically significant differences in DC value, DRs and HRV indexes between different groups (P>0.05). In school-age children, the DC value of VVS group was significantly higher than that of control group. In adolescent children, DC value, DR4, DR8 and LF of VVS group were significantly higher than those of control group (P<0.05). DC was positively correlated with HRV indexes (r=0.31~0.67, P<0.05), and negatively correlated with LF/HF (r=-0.36, P<0.05). Binary logistic regression analysis showed that only DC was associated with VVS in adolescent children (P<0.05). The receiver operating characteristic curve (ROC) was used to analyze the predictive value of DC, and it was found that when the DC value was 7.72 ms in school age children and 8.36 ms adolescent chidlren, there was good sensitivity and specificity. Conclusion The autonomic nerve function was abnormal in asymptomatic stage of VVS children, and it became more significant with age. Both school-age and adolescent children with VVS had increased vagus nerve tension, and adolescent VVS children had a certain degree of increased sympathetic nerve tension. The DC has an obvious positive correlation with vagus nerve tension and has a good predictive value for the diagnosis of VVS.

Key words: vasovagal syncope; heart rate deceleration; heart rate deceleration runs; heart rate variability;  autonomic nerve function