儿童特发性室性期前收缩临床特点及其对左心功能影响分析

doi:10.12372/jcp.2023.23e0116

摘要/Abstract

摘要：

目的探讨儿童特发性室性期前收缩（PVC）的临床特点，并分析其影响左心室收缩功能的危险因素。方法回顾性分析2015年7月至2020年12月住院的特发性PVC患儿的临床资料。对随访超过3年者，根据第3年超声心动图评估的左室射血分数（LVEF），分为LVEF降低组和LVEF无改变组，分析特发性PVC患儿并发LVEF降低的危险因素。结果纳入特发性PVC 患儿393例，男227例、女166例，中位年龄5.0（2.0~8.0）岁。有症状者66例，主要表现为胸闷、胸痛；右心室起源273例；PVC低负荷（PVC占总心搏百分比<10%）284例，最高负荷46.0%。212例患儿2年内规律随访，24个月总好转率为73.6%，使用抗心律失常药物者及未用药者好转率差异无统计学意义（P>0.05）。随访超过3年者147例，其中LVEF降低组23例，LVEF无改变组124例。两组间存在非持续性室性心动过速比例、PVC负荷差异有统计学意义（P<0.05）。多因素logistic回归分析显示，PVC负荷增高是特发性PVC患儿LVEF降低的独立危险因素（P<0.05），其预测特发性PVC患儿出现LVEF降低的ROC曲线下面积为0.88（95%CI：0.79~0.96）。讨论儿童特发性PVC通常无明显症状，多数预后良好，药物治疗不能改善患儿预后。儿童特发性PVC在较长的随访时间内，可能会出现左心收缩功能降低，PVC负荷可作为预测PVC患儿左心功能降低的指标。

关键词: 室性期前收缩, 临床特点, 室性期前收缩负荷, 左室射血分数

Abstract:

Objective To investigate the clinical features of idiopathic premature ventricular contractions (PVCs) in children, and to analyze the risk factors leading to left ventricular (LV) dysfunction. Methods The clinical data of idiopathic PVCs children hospitalized from July 2015 to December 2020 were retrospectively analyzed. Patients followed up for more than 3 years were divided into LVEF reduction group and LVEF unchanged group according to the left ventricular ejection fraction (LVEF) assessed by echocardiography at the third year. The risk factors of LVEF reduction in idiopathic PVCs children were analyzed. Results A total of 393 children with idiopathic PVCs (227 boys and 166 girls) were included, and the median age was 5.0 (2.0-8.0) years. Sixty-six children with symptoms mainly presented as chest tightness and chest pain and 273 cases of PVCs originated from right ventricle. The burden of PVCs in 284 children was less than 10%, and the highest burden was 46%. Two hundred and twelve children were followed up regularly within 2 years, and the total improvement rate at 24 months was 73.6%. There was no statistically difference in the recovery rate between patients with and without antiarrhythmic drugs (P>0.05). One hundred and forty-seven children were followed up for more than 3 years including 23 children in LVEF reduction group and 124 children in LVEF unchanged group. There were significant differences in the proportion of unsustained ventricular tachycardia and PVCs burden between the two groups (P<0.05).Multivariate logistic regression analysis showed that increased PVCs burden was an independent risk factor for LVEF reduction in idiopathic PVCs children (P<0.05), and the area under the ROC curve for predicting LVEF reduction in idiopathic PVCs children was 0.88 (95%CI: 0.79-0.96). Conclusions Idiopathic PVCs in children usually has no obvious symptoms, most of the children have a good prognosis, and antiarrhythmic drugs cannot improve the prognosis of PVCs in children. Children with idiopathic PVCs may occur LV dysfunction during a long follow-up period. The PVCs burden can be used as a predictor of LV dysfunction in children with idiopathic PVCs.

Key words: premature ventricular contraction, clinical feature, premature ventricular contractions burden, left ventricular ejection fraction

陈烨, 周万平, 黎璇, 候淼, 曹磊, 孙凌, 吕海涛. 儿童特发性室性期前收缩临床特点及其对左心功能影响分析[J]. 临床儿科杂志, 2023, 41(12): 925-930.

CHEN Ye, ZHOU Wanping, LI Xuan, HOU Miao, CAO Lei, SUN Ling, LYU Haitao. Clinical features of idiopathic premature ventricular contractions in children and its influence on left ventricular function[J]. Journal of Clinical Pediatrics, 2023, 41(12): 925-930.

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项目	药物组(n=81)	非药物组(n=131)	统计量	P
男性[n(%)]	44(54.3)	76(58.0)	χ²=0.28	0.598
年龄[M(P₂₅~P₇₅)]/岁	4.0(2.0~7.0)	5.0(2.0~9.0)	Z=0.66	0.511
有临床症状[n(%)]	27(33.3)	17(13.0)	χ²=0.62	0.432
初诊PVC占总心搏比例[M(P₂₅~P₇₅)]/%	16.0(11.8~21.0)	7.0(4.8~8.8)	Z=11.11	<0.001
初诊LVEF（$\bar{x} \pm s$）/%	70.1±.4.6	70.2±4.2	t=0.10	0.924
随访1月好转[n(%)]	53(65.4)	79(60.3)	χ²=0.56	0.454
随访6月好转[n(%)]	56(69.1)	87(66.4)	χ²=0.17	0.681
随访12月好转[n(%)]	60(74.1)	87(66.4)	χ²=1.38	0.240
随访24月好转[n(%)]	64(79.0)	89(67.9)	χ²=3.06	0.080

项目	LVEF无改变组(n=124)	LVEF降低组(n=23)	统计量	P
男性[n(%)]	69(55.6)	15(65.2)	χ²=0.73	0.394
年龄[M(P₂₅~P₇₅)]/岁	4.0(2.0~9.0)	4.0(2.0~6.0)	Z=0.22	0.824
身高[M(P₂₅~P₇₅)]/cm	105.0(90.0~139.0)	103.0(90.0~124.0)	Z=0.42	0.675
体重[M(P₂₅~P₇₅)]/kg	17.0(13.0~30.8)	18.0(14.5~20.8)	Z=0.09	0.928
有临床症状[n(%)]	18(14.5)	1(4.3)	χ²=0.99	0.319
起源部位(左)[n(%)]	68(54.8)	12(52.2)	χ²=0.06	0.814
PVC联律[n(%)]	77(62.1)	14(60.9)	χ²=0.01	0.911
成对PVC[n(%)]	13(10.5)	2(8.7)	χ²=0.00	1.000
非持续性室速[n(%)]	13(10.5)	15(65.2)	χ²=9.36	0.006
插入性PVC[n(%)]	4(3.2)	0(0)	-	1.000¹⁾
PVC-QRS时限($\bar{x} \pm s$)/ms	108.6±23.6	112.4±25.0	t=0.80	0.483
PVC负荷[M(P₂₅~P₇₅)]/%	8.0(5.4~12.0)	20.3(16.0~28.4)	Z=5.69	<0.001
rmSSD($\bar{x} \pm s$)/ms	71.6±5.7	67.1±7.2	t=0.10	0.921
pNN50[M(P₂₅~P₇₅)]/%	26.0(18.0~38.0)	32.0(19.0~52.0)	Z=1.46	0.145
SDNN[M(P₂₅~P₇₅)]/ms	110.0(86.5~132.8)	106.0(85.0~139.0)	Z=0.24	0.810
PVC联律间期($\bar{x} \pm s$)/ms	409.7±83.2	401.7±76.6	t=0.90	0.669
PVC提前率($\bar{x} \pm s$)/%	0.7±0.1	0.7±0.1	t=0.53	0.614

危险因素	偏回归系数	标准误	χ²值	P	OR(95%CI)
PVC负荷	0.14	0.03	22.01	<0.001	1.16(1.09~1.23)
存在非持续性室速	0.68	0.73	0.86	0.355	1.97(0.47~8.26)
常量	-3.87	0.59	43.35	<0.001	-