超重/肥胖儿童自主神经功能综合评价

doi:10.12372/jcp.2022.21e1232

摘要/Abstract

摘要：

目的评估超重/肥胖儿童的自主神经功能情况。方法通过研究动态心电图的心率变异性（HRV）及心率减速力（DC）指标,平板运动试验的运动当量、达峰值心率（HR_max）的运动时间、运动终止后第一分钟心率恢复（HRR₁）、恢复至静息心率时间、静息期收缩压、运动峰值收缩压及运动恢复期第三分钟收缩压指标来评估肥胖儿童的自主神经功能。结果肥胖组儿童31例,男23例、女8例,平均年龄（10.4±2.6）岁;超重组69例,男35例、女34例,平均年龄（10.9±2.7）岁;对照组100例,男57例、女43例,平均年龄（10.2±2.7）岁。超重、肥胖与对照组三组儿童之间正常RR间期标准（SDNN）、相邻RR间期差值的均方根（RMSSD）、5 min均值标准差（SDANN）、NN50占所有NN间期个数的百分数（pNN₅₀）、低频功率（LF）/高频功率（HF）、心率减速力（DC）值的差异均有统计学意义（P<0.05）。超重、肥胖与对照组三组儿童之间达HR_max运动时间、运动当量、HRR₁/HR_max、恢复至静息心率时间、静息期收缩压、运动峰值收缩压、恢复期第三分钟收缩压/峰值收缩压的差异均有统计学意义（P<0.05）。结论超重/肥胖儿童存在心脏自主神经功能紊乱,尤其迷走神经功能的受损,需要引起足够重视,积极干预,预防心血管事件的发生。

关键词: 肥胖, 自主神经功能, 心率变异性, 心率减速力, 儿童

Abstract:

Objective To evaluate the autonomic nervous function in overweight and obese children. Methods Heart rate variability (HRV) and heart rate deceleration force (DC) of holter electrocardiogram results were studied. Exercise equivalent, exercise time to peak heart rate (HR_max), heart rate recovery at 1 min after exercise (HRR₁), recovery time to resting heart rate, systolic blood pressure at resting period, systolic blood pressure at peak exercise and systolic blood pressure at 3 min during exercise recovery period were used to evaluate autonomic nervous function in overweight and obese children. Results There were 31 children (23 boys and 8 girls) in the obesity group, with an average age of (10.4±2.6) years. There were 69 children (35 boys and 34 girls) in the overweight group, with an average age of (10.9±2.7) years. The control group consisted of 100 children (57 boys and 43 girls) with an average age of (10.2±2.7) years. There were statistically significant differences among overweight, obesity and control groups in standard deviation of normal R-R intervals (SDNN), squares of differences between adjacent NN intervals (RMSSD), averages of NN intervals in all 5-min segments (SDANN), percent of NN 50 in the total number NN intervals (pNN₅₀), low frequency (LF)/high frequency (HF) and DC value (P<0.05). The HR_max, exercise equivalent, HRR₁/HRR_max, the time to recover to resting heart rate, the systolic blood pressure at resting period, the peak exercise systolic blood pressure and the systolic blood pressure/peak systolic blood pressure in the third minute of recovery among overweight, obesity and control groups were statistically significant (P<0.05). Conclusions Overweight and obese children have cardiac autonomic nervous dysfunction, especially impaired vagus nerve function, which requires sufficient attention and active intervention to prevent the occurrence of cardiovascular events.

Key words: obesity, autonomic nerve function, heart rate variability, deceleration capacity of rate, child

张丽, 李筠, 王健怡, 肖婷婷, 谢利剑, 徐萌. 超重/肥胖儿童自主神经功能综合评价[J]. 临床儿科杂志, 2022, 40(7): 505-509.

ZHANG Li, LI Yun, WANG Jianyi, XIAO Tingting, XIE Lijian, XU Meng. Comprehensive evaluation of autonomic nerve function in overweight/obese children[J]. Journal of Clinical Pediatrics, 2022, 40(7): 505-509.

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组别	SDNN	RMSSD	SDANN	pNN₅₀	LF/HF	DC
肥胖组	122.0 (65.0~150.0)¹⁾	36.0 (21.0~44.0)¹⁾	105.0 (76.0~141.0)¹⁾	13 779.0 (472.0~22 006.0)¹⁾	2.0 (1.23~2.7)¹⁾	6.4 (5.3~7.8)¹⁾²⁾
超重组	128.0 (92.5~162.0)¹⁾	39.0 (27.0~48.5)¹⁾	114.0 (83.5~155.0)¹⁾	15 653.0 (5 133.0~24 559.5)¹⁾	1.4 (1.0~2.3)¹⁾	7.2 (6.4~8.1)
对照组	135.5 (114.0~160.0)	42.5 (33.0~55.7)	123.0 (102.0~142.7)	21 157.0 (12 391.0~29 633.2)	1.1 (0.8~1.5)	7.4 (6.7~8.2)
H值	7.15	8.50	6.37	14.11	14.78	6.58
P	0.028	0.014	0.042	0.001	0.001	0.032

项目	肥胖组	超重组	对照组	H值	P
静息心率/次·min^-1	102.0(88.0~116.0)	100.0(88.0~116.0)	100.0(92.0~106.0)	0.62	0.733
HR_max/次·min^-1	181.0(179.0~181.0)	181.0(179.0~184.0)	181.0(179.0~183.0)	0.21	0.897
达HR_max运动时间/s	422.0(390.0~577.0)	480.0(413.0~562.0)	564.0(471.0~602.0)	23.48	<0.001
运动当量/mets	8.6(7.7~11.0)	10.0(8.2~10.8)	10.7(9.7~11.7)	21.40	<0.001
HRR₁/HR_max	0.1(0.1~0.2)	0.2(0.1~0.2)	0.2(0.1~0.2)	9.89	0.007
恢复至静息心率时间/s	360.0(328.0~360.0)	360.0(320.0~360.0)	322.0(312.0~360.0)	15.71	<0.001
静息期收缩压/mmHg	117.0(112.0~132.0)¹⁾	118.0(110.0~125.0)¹⁾	108.5(99.0~114.0)	37.49	<0.001
运动峰值收缩压/mmHg	152.0(140.0~161.0)¹⁾	145.0(137.0~156.0)¹⁾	135.0(128.0~144.0)	34.57	<0.001
恢复期第三分钟收缩压/峰值收缩压	0.91(0.85~0.93)¹⁾²⁾	0.87(0.85~0.93)¹⁾	0.85(0.82~0.87)	19.85	<0.001