心率变异在儿童躯体形式自主神经紊乱与儿童心肌炎鉴别诊断中的意义

Differential diagnostic value of heart rate variability analysis in children with somatoform autonomic dysfunction and virus myocarditis

目的 :探讨心率变异 (HRV)对于儿童躯体形式自主神经紊乱及心肌炎鉴别诊断的意义 .方法 :对 4 9例躯体形式自主神经紊乱患儿、4 7例病毒性心肌炎患儿、4 0例正常儿童行 2 4h动态心电图分析 ,观察HRV时域、频域十项指标 2 4h、清醒期和睡眠期的改变 .结果 :躯体形式自主神经紊乱和心肌炎患儿均存在HRV异常 ,前者HRV升高 ,总功率谱密度 (TP) [(40 0 9± 10 0 5 )vs (312 1± 5 6 9)ms2 /Hz](P <0 .0 17vscontrol) ,高频 (HF) [(831± 371)vs (6 6 7± 16 )ms2 /Hz](P <0 .0 17vscontrol) ,睡眠期与清醒期差值增大 ,HF[(497± 2 10 )vs(2 15± 2 5 3)ms2 /Hz](P <0 .0 17vscontrol) ,pNN50 (2 7± 16 ) %vs (14± 17) % (P <0 .0 17vscontrol) ;后者HRV持续降低 ,TP [(2 6 4 7± 132 8)vs (312 1± 5 6 9)ms2 /Hz](P <0 .0 17) ,HF [(30 5± 199)vs (6 6 7± 16 )ms2 /Hz](P <0 .0 17) ;睡眠期与清醒期差值减小或消失 ,HF [(7±4 2 )vs (2 15± 2 5 3)ms2 /Hz](P <0 .0 17) ,pNN50 (1± 6 ) %vs(14± 17) % (P <0 .0 17) .结论 :HRV对于躯体形式自主神经紊乱及心肌炎患儿的诊断和鉴别诊断具有重要意义 .

AIM: To study the differential diagnostic value of heart rate variability (HRV) in children with somatoform autonomic dysfunction and virus myocarditis. METHODS: Twenty-four-hour HRV was examined in 49 children with somatoform autonomic dysfunction, 47 children with virus myocarditis and 40 healthy children. The HRV changes in awake- time and sleeping-time were observed. RESULTS: HRV abnormality was found in children with somatoform autonomic dysfunction and those with virus myocarditis. In the former group, HRV increased, with total power (TP) [(4009±1005) vs (3121±569) ms 2/Hz] (P<0.017 vs control) and high frequency (HF) [(831±371) vs (667±16) ms 2/Hz] (P<0.017 vs control). The difference between the sleeping and awake time increased significantly, with HF [(497±210) vs (215±253) ms 2/Hz] (P< 0.017) and pNN 50 (27±16)% vs (14±17)% (P<0.017). In the latter group, HRV decreased continuously, with TP [(2647±1328) vs (3121±569) ms 2/Hz] (P<0.017) and HF [(305±199) vs (667±16) ms 2/Hz] (P<0.017). The difference between sleeping and awake time decreased significantly, with HF [(7±42) vs (215±253) ms 2/Hz] (P< 0.017) and pNN 50 (1±6)% vs (14±17)% (P<0.017). CONCLUSION: Different HRV changes occur in children with somatoform autonomic dysfunction and those with myocarditis, which are of significance in the differentiation of the two diseases.