心率变异性监测对小儿甲状腺功能亢进症自主神经功能的评价

Assessment of the function autonomic nerve in children with hyperthyroidism by analyzing heart rate veriability function

目的 监测小儿甲状腺功能亢进症 (简称甲亢 ) 2 4h心率变异性 (HRV)的昼夜规律 ,探讨其自主神经功能异常的意义。方法 2 4h动态心电图记录后 ,分别对 13例甲亢和 2 6例正常小儿 (对照组 )的HRV进行分析。结果 ① 2 4h总HRV时域和频域指标提示甲亢组与对照组比较均有显著差异 (P <0 0 1)。②清醒期和睡眠期频域指标比较 :对照组低频标准单位 (LFNU)、低频 /高频比率 (LF/HF)在清醒期明显增高 (P <0 0 1) ,高频带 (HF)、高频标准单位 (HFNU)在睡眠期明显增高 (P <0 0 1) ;甲亢组总功率谱密度 (TP)、极低频带 (VLF)、低频带 (LF)、HF、LFNU、HFNU、LF/HF在清醒期和睡眠期比较无显著差异。③各组 2 4h的HRV时域动态变化比较 :对照组 2 4h的HRV时域变化有明显昼夜节律 ,以相邻正常RR间期差值均方根 (RMSSD)和相邻正常RR间期差值 >5 0ms占RR间期总数的百分比 (PNN50 )指标最敏感 ;甲亢组 2 4h的HRV时域各指标明显低于对照组 (P <0 0 1) ,失去昼夜规律。结论 甲亢患儿心脏自主神经受损 ,以迷走神经更严重。由于持续性的甲状腺素刺激 ,而表现为持续性交感神经占优势 ,失去昼夜规律 ,及时控制甲亢 。

Objective To assessment autonocmic nervous system (ANS) function in patients with hyperthyroidism by studying the heart rate variability (HRV) of 24 hrs.Methods Indexes of HRV were measured in 13 hyperthyroidism and 26 healthy controls.Results 1.There was significance different(P<0 01)of time domain indexes in the hyperthyroidism and the control over a 24 hour period.2.In the control group,there was a significant increase(P<0 01)in the indexes of LF NU and LF/HF during waking hours,and in the indexes of HF,HF NU (P<0 01)during sleeping hours;whereas there was no significant difference of TP,VLF,LF,HF,LF NU and LF/HF and LF/HF in the hyperthyroidism both in waking and sleeping hours.3.Comparing time domain indexes of HRV over 24 hour period in two groups:there were significant changes of time domain indexes of HRV in the control,with RMSSD and PNN 50 easily affected;whereas less significant in the hyperthyroidism.Conclusin Patients with hyperthyroidism had autonomic imbalance,especially vagal imbalance.As a result of continual thyroid hormone excess,there was a relative hyper sympathetic tone,over controlling hyperthyroidism.Thus it is of non neglected value of adjusting autonomic balance in treating hperthyroid cardiac disease.