小儿心内膜弹力纤维增生症心率变异改变及其与心脏结构功能的相关性研究

Changes of heart rate variability and its relativity with cardiac size and function in children with endocardial fibroclastosis

目的研究心内膜弹力纤维增生症(EFE)患儿的心率变异(HRV)改变及其与心脏结构和功能的相关性。方法对山东省立医院儿科30例EFE患儿和20例健康儿童分别进行24h心率变异分析,得出SDNN、SDANN、PNN50、rMSSD、LF、HF及LF/HF等指标。行常规超声心动图检查,取得左房舒张末期前后径(LAED)、左室舒张末期前后径(LVED)、室间隔舒张末期厚度(IVSTd)、心脏指数(CI)、左室射血分数(LVEF)、短轴缩短率(LVFS)、二尖瓣舒张早期血流速度峰值(E)、舒张晚期血流速度峰值(A)、峰值速度比值(E/A)及左房射血力(LAF)等指标。对两组的上述指标进行比较,并分析心内膜弹力纤维增生症患儿的心率变异性与心脏结构和功能的相关性。结果与对照组相比,EFE组的LAED和LVED明显增大,IVSTd明显增厚,CI、LVEF、LVFS、二尖瓣E峰均显著降低,LAF明显增大,二尖瓣A峰及E/A变化不明显;心率变异指标中SDNN、PNN50、rMSSD、LF、HF均明显降低,LF/HF升高,SDANN无明显改变;SDNN与LVEF、LVFS强相关,与CI、LAF、LVED、IVSTd中等相关,LF/HF与LAF中等相关,其余HRV指标与心脏的结构和心功能的指标间无明显的相关性。结论EFE患儿存在HRV的异常改变,表现为植物神经的普遍受损,HRV中部分指标的改变与房室腔扩大、心内膜增厚和心功能下降有一定的相关性,部分HRV指标是相对独立的,将HRV指标与超声指标结合起来能更好的指导临床。

Objective To investigate the changes of heart rate variability （ HRV ） and its relativity with cardiac size and function in children with endocardial fibroclastosis （ EFE ）. Methods Totally 30 children with EFE were enrolled in this study. Control group consisted of 20 normal children. They received Hoher ECG and color Doppler echocardiography respectively. Twenty-four-hour HRV parameters included SDNN, SDANN, rMSSD, PNN50, LF, HF and LF/HF. Echocardio- graphy parameters included end-diastolic diameter of left atrial （LAED）, end-diastolic diameter of left ventricle （LVED） , diameter of interventricular septal （ IVSTd ） , cardiac index （ CI ） , left ventricular ejection fraction （ LVEF ） , fractional shorting（LVFS） ,mitral early diastolic peak volicity （E peak ）, late diastolic peak volicity （A peak ）, early-to- late ratio（ E/A） and left atrial ejection force （ LAF）. Linear regression was used to analyze the relativity between HRV and echocardiography parameters. Results LAED, LVED, IVSTd, LAF and LF/HF were significantly greater while CI, LVEF, LVFS, E peak, SDNN, PNN50, rMSSD, LF and HF were significantly lower than that in the control group. SDNN was strongly correlated with LVEF and LVFS while moderately with CI, LAF, LVED and IVSTd. LF/HF was moderately related to LAF. Conclusion Both vagal and sympathetic nerve impairment are suggested in children with EFE. Some HRV parameters correlate with abnormality of cardiac structure,function and hypertrophy of endocardial,while others are independent. Further study is needed to investigate the prognostic value of HRV in EFE children.