儿童癫痫的心率变异性分析

Analysis of heart rate variability in children with epilepsy

目的分析心率及心率变异性与癫痫发生及发作的相关性,并揭示相关指标在癫痫中的诊断价值。方法以2017年2月至2018年5月复旦大学附属儿科医院收治的79例儿童癫痫患儿为研究对象。癫痫患儿进一步分为发作组(69例)和非发作组(10例),发作组又分为局灶性发作组(49例)和全面性发作组(20例)。选取同期13例因非癫痫性发作事件入院行视频脑电图检查的儿童为非癫痫组。所有患儿在癫痫发作期及非发作期均行长程视频脑电图及同步心电监测。心率及心率变异性指标符合正态分布的数据采用独立样本t检验,反之,采用非参数Mann-Whitney检验。受试者工作特征曲线(ROC)用于评估相关指标在癫痫发生及发作中的诊断价值。结果全部窦性心搏RR间期标准差(SDNN)指数在癫痫组明显低于非癫痫组(60.13±20.18比77.08±28.49,t=-2.637,P=0.010),在非发作期癫痫组中同样明显低于非癫痫组(53.40±14.77比77.08±28.49,t=-2.385,P=0.027)。ROC曲线分析表明SDNN指数在癫痫组阈值[阈值=67.5,曲线下面积(AUC)=0.673,P=0.047,敏感性65.8%,特异性69.2%]及非发作期癫痫组(阈值=65.0,AUC=0.750,P=0.044,敏感性80.0%,特异性69.2%)中均表现出一定的诊断价值。然而,SDNN指数在非发作期与发作期癫痫、局灶性与全面性癫痫中差异均无统计学意义(均P>0.05)。除SDNN指数外的其他心率变异性指标(包括全部窦性心搏R-R间期标准差、相邻R-R间期差值的均方根、相邻R-R之差>50 ms的个数占总窦性心搏个数的百分比、每5 min时间段窦性R-R间期平均值标准差、低频、高频、低频/高频比值)和心率指标(包括平均心率,最小心率,最大心率,差值心率及最大心室搏动间期)在各组患者之间差异均无统计学意义(均P>0.05)。结论癫痫儿童的SDNN指数明显降低。SDNN指数可用于儿童癫痫的辅助诊断。

Objective To analyze the correlation of heart rate(HR)/heart rate variability(HRV)with the occurrence and development of epilepsy,so as to reveal the diagnostic value of related indicators in epilepsy.Methods Totally,79 epilepsy children who were sent to Children′s Hospital of Fudan University from February 2017 to May 2018 were enrolled in this study.Epilepsy patients were further divided into seizure group(69 cases)and non-seizure group(10 cases).Seizure group was further divided into focal seizure group(49 cases)and comprehensive seizure group(20 cases).A total of 13 children with non-seizure epilepsy admitted to hospital for video electroencephalogram during the same period were selected as non-epilepsy group.All children obtained long-term video electroencephalogram and synchronous electrocardiogram(ECG)during seizure and non-seizure period.In accordance with normal distribution,the data of HR and HRV was analyzed through independent-samples t test,and the date without normal distribution was analyzed by carrying out non-parameter Mann-Whitney test.The diagnostic value of related indexes in epilepsy was evaluated via receiver operating characteristic curve(ROC).Results Standard deviation of sinus RR intervals(SDNN)index was obviously lower in epilepsy group than that in non-epilepsy group(60.13±20.18 vs.77.08±28.49,t=-2.637,P=0.010),and remarkably lower in non-seizure group than that in non-epilepsy group(53.40±14.77 vs.77.08±28.49,t=-2.385,P=0.027).ROC analysis indicated that SDNN index had certain diagnostic value in epilepsy(cutoff=67.5,AUC=0.673,P=0.047,sensitivity was 65.8%,specificity was 69.2%)and non-seizure epilepsy(cutoff=65.0,AUC=0.750,P=0.044,sensitivity was 80.0%,specificity was 69.2%).However,SDNN index was not significantly different between non-seizure and seizure group,and between focal seizure and comprehensive seizure group(all P>0.05).HRV indexes,including SDNN,root mean square differences of successive R-R intervals,the ratio obtained by dividing total number of the number of differences in consecutive R-R intervals greater than 50 ms,mean standard deviation of sinus R-R interval per 5 min period,low frequency(LF),high frequency(HF),LF/HF,and HR indexes,including mean HR,minimum HR,maximum HR,HR difference value and maximum RR,were not significantly different between epilepsy and non-epilepsy group,between non-seizure epilepsy and non-epilepsy group,between non-seizure and seizure group,and between focal seizure and generalized seizure group(all P>0.05).Conclusions SDNN index greatly reduced in epilepsy,including non-seizure patients.SDNN index can be applied to assist the diagnosis of epilepsy in children.