直立倾斜试验不同时间点心率和心率差对儿童及青少年体位性心动过速综合征的诊断效率

Efficiency of heart rate and heart rate difference at different time points during head-up tilt test in the diagnosis of postural tachycardia syndrome in children and adolescents

目的探讨直立倾斜试验(HUTT)不同时间点心率(HR)和心率差(HRD)对儿童及青少年体位性心动过速综合征(POTS)的诊断效率。方法选择诊断为POTS的6~16岁儿童及青少年217例为POTS组,匹配同期健康的儿童及青少年73例为对照组。POTS组又分为≤12岁亚组(n=127)和>12岁亚组(n=90)。分析比较两组儿童及青少年基线时、HUTT 5 min、HUTT 10 min的HR(HR0、HR5、HR10)及HUTT 5 min、HUTT 10 min的HR与HR0的差值(HRD5、HRD10),并分析HR5、HR10、HRD5、HRD10对POTS的诊断效率。结果POTS组HR5、HR10、HRD5、HRD10较对照组明显增加(P<0.05)。HUTT 5 min时HR或HRD对男性患儿诊断POTS符合率高于女性患儿(P<0.05),HUTT 10 min时HR或HRD对男性患儿诊断POTS符合率低于女性患儿(P<0.05)。>12岁亚组HR诊断POTS符合率更高(P<0.05),≤12岁亚组HRD诊断POTS符合率更高(P<0.05)。HR5、HR10、HRD5和HRD104项联合预测诊断POTS的曲线下面积(0.974,95%CI:0.949~0.989)大于上述各单项指标预测的曲线下面积(P<0.05),且灵敏度(87.80%)和特异度(95.83%)最高。HRD诊断效能高于HR(P<0.05)。结论HUTT不同时间点的HR和HRD对预测诊断儿童及青少年POTS具有较高价值,诊断POTS符合率存在年龄和性别差异。

Objective To study the efficiency of heart rate(HR)and heart rate difference(HRD)at different time points during head-up tilt test(HUTT)in the diagnosis of postural tachycardia syndrome(POTS)in children and adolescents.Methods A total of 217 children and adolescents,aged 6-16 years,who were diagnosed with POTS were enrolled as the POTS group,and 73 healthy children and adolescents,matched for sex and age,were enrolled as the control group.The POTS group was further divided into≤12 years old group with 127 children/adolescents and>12 years old group with 90 children/adolescents.The two groups were compared in terms of HR at baseline and at 5 and 10 minutes of HUTT(HR0,HR5,and HR10 respectively),difference between HR5/HR10 and HR0(HRD5 and HRD10 respectively).The efficiency of HR5,HR10,HRD5 and HRD10 in the diagnosis of POTS was assessed.Results Compared with the control group,the POTS group had significant increases in HR5,HR10,HRD5,and HRD10(P<0.05).The coincidence rate of HR or HRD for the diagnosis of POTS in males was higher than that in females at 5 minutes of HUTT(P<0.05),while the coincidence rate of HR or HRD for the diagnosis of POTS in males was lower than that in females at 10 minutes of HUTT(P<0.05).The coincidence rate of HR for the diagnosis of POTS was higher in the>12 years old subgroup(P<0.05),while the coincidence rate of HRD for the diagnosis of POTS was higher in the≤12 years old subgroup(P<0.05).The combination of HR5,HR10,HRD5,and HRD10 for the diagnosis of POTS had a greater area under the curve(0.974;95%CI:0.949-0.989)than HR5,HR10,HRD5,or HRD10 alone,with a sensitivity of 87.80%and a specificity of 95.83%.The diagnostic efficacy of HRD for POTS was higher than that of HR(P<0.05).Conclusions HR and HRD at different time points during HUTT have a good value in the diagnosis of POTS in children and adolescents,and the accuracy of diagnosis varies with age and gender.