不明原因胸闷痛静息期儿童卧位与立位心电图T波及ST段振幅变化的临床意义

Clinical significance of changes in T wave and ST segment amplitudes on electrocar diogram from supine to standing position among children with unexplained chest tightness or pain in resting stage

目的探讨不明原因胸闷痛儿童静息期卧位与立位心电图T波及ST段振幅变化的临床意义。方法选取以不明原因胸闷痛（静息期）为主诉的6~14岁儿童122例行直立倾斜试验（HUTT）,分HUTT阳性组（n=61）和HUTT阴性组（n=61）。测量卧位与立位12导联心电图的心率及Ⅱ、Ⅲ、aVF、V5导联T波和ST段振幅。结果 （1）HUTT阴性组：立位较卧位心率增快（P〈0.05）,Ⅱ、Ⅲ、aVF、V5导联T波振幅降低（P〈0.05）;Ⅱ、aVF、V5导联ST段振幅增加（P〈0.05）。（2）HUTT阳性组：立位较卧位心率增加（P〈0.05）,Ⅱ、Ⅲ、aVF、V5导联T波振幅降低（P〈0.05）;V5导联ST段振幅增加（P〈0.05）。（3）T波振幅及ST段振幅变化：立位与卧位心电图Ⅱ、Ⅲ、aVF、V5导联T波及ST段振幅在HUTT阳性组、HUTT阴性组之间差异无统计学意义（P〉0.05）。（4）卧位与立位心电图T波和ST段振幅差比较：HUTT阳性组卧位与立位心电图Ⅱ、Ⅲ、aVF、V5导联T波振幅差及心率差较HUTT阴性组增加（P〈0.05）。结论不明原因胸闷痛静息期儿童HUTT阳性组卧位与立位心电图T波振幅差及心率差较HUTT阴性组增加,表明卧位与立位心电图T波振幅变化对提示自主神经功能紊乱具有临床价值。

Objective To investigate the clinical significance of changes in T wave and ST segment amplitudes on electrocardiogram （ECG） from supine to standing position in children with unexplained chest tightness or pain in resting stage. Methods A total of 122 6-14-year-old children with a chief complaint of unexplained chest tightness or pain （resting stage） underwent head-up tilt test （HUTT）. According to HUTT results, these children were divided into HUTT- positive （n=61） and HUTT-negative groups （n=61）. They underwent 12-lead ECG in the supine and standing positions, and heart rate and T wave and ST segment amplitudes in II, III, aVF and V5 leads were measured. Results In the HUTT-negative group, heart rates were significantly higher in the standing position than in the supine position （P〈0.05）, T wave amplitudes in II, III, aVF, and V5 leads were significantly lower in the standing position than in the supine position （P〈0.05）, and ST segment amplitudes in II, aVF and V5 leads were significantly higher in the standing position than in the supine position （P〈0.05）. In the HUTT-positive group, heart rates were significantly higher in the standing position than in the supine position （P〈0.05）, T wave amplitudes in II, III, aVF and V5 leads were significantly lower in the standing position than in the supine position （P〈0.05）, and ST segment amplitude in V5 lead was significantly higher in the standing position than in the supine position （P〈0.05）. There were no significant differences between the two groups with respect to ST segment amplitude and T wave amplitude in II, III and aVF leads of the supine or standing position （P〉0.05）. Compared with the HUTT-negative group, the HUTT-positive group had significantly greater T wave amplitude differences in II, III, aVF and V5 leads, and heart rate difference from supine to standing position （P〈O.05）. Conclusions Among the children with unexplained chest tightness or pain in resting stage, T wave amplitude differences in II, III, aVF and V~ leads and heart rate difference from supine to standing position are greater in the HUTT-positive group than in the HUTT-negative group. This suggests that the changes in T wave amplitude on ECG from supine to standing position can indicate autonomic nervous system dysfunction.