儿童直立性高血压12导联心电图检查及其临床意义研究

12-lead electrocardiogram for orthostatic hypertension in children and its clinical significance

目的探究儿童直立性高血压患儿的12导联心电图表现及其临床意义,为患儿的临床诊疗提供指导。方法选择2017年1月至2019年12月在诸暨市第二人民医院儿科进行诊治的直立性高血压(OHT)患儿34例作为OHT组,另选择同期进行常规体检的健康儿童34例作为对照组。两组儿童均进行卧位、立位12导联心电图检查,比较两组儿童卧、立位心电图T波振幅差和ST段振幅差。结果OHT组患儿的Ⅱ、V_(5)、V_(6)导联T波振幅差分别为(0.07±0.11)mV、(0.13±0.12)mV、(0.14±0.11)mV,均明显高于对照组的(0.02±0.07)mV、(0.05±0.06)mV、(0.03±0.04)mV,差异均有统计学意义(t=2.24、3.48、5.48,P=0.029、0.001、<0.001),两组儿童其余导联T波振幅差相比,差异均无统计学意义(均P>0.05)。两组儿童的12导联ST段振幅差相比,差异无统计学意义(P>0.05)。Ⅱ导联、V_(5)导联T波振幅差在预测儿童OHT上的曲线下面积(AUC)分别为0.596、0.672,敏感度、特异度分别为64.71%、55.88%和70.59%、61.76%,诊断效能相对较低。V_(6)导联T波振幅差的AUC为0.738,其敏感度和特异度分别为76.47%、67.65%,诊断效能中等。结论V_(6)导联卧、立位T波振幅差对于预测诊断儿童OHT具有一定诊断价值,12导联心电图检查能够为儿童OHT的临床预测和诊断提供重要参考。

Objective To investigate the 12-lead electrocardiogram findings and their clinical significance in children with orthostatic hypertension(OHT),providing evidence for clinical diagnosis and treatment of OTH.Methods Thirty-four children with OHT who received diagnosis and treatment in the Zhuji Second People's Hospital from January 2017 to December 2019 were included in the OHT group.An additional 34 healthy children who concurrently received routine physical examination were included in the control group.Both groups of children underwent a 12-lead electrocardiogram in lying and standing positions.The changes in ST-segment and T-wave amplitudes in the lying position relative to the standing position were compared between the two groups.Results The changes in T-wave amplitude of leads II,V_(5),and V_(6) in the OHT group were(0.07±0.11)mV,(0.13±0.12)mV,and(0.14±0.11)mV,respectively,which were significantly higher than those in the control group[(0.02±0.07)mV,(0.05±0.06)mV,(0.03±0.04)mV,t=2.24,3.48,5.48,P=0.029,0.001,<0.001).There were no significant differences in the changes in T-wave amplitude of other leads between the two groups(all P>0.05).There was no significant difference in change in ST-segment amplitude on 12-lead electrocardiogram images between the two groups(all P>0.05).The area under the curve of the changes in T-wave amplitude of leads II and V_(5) in predicting OHT in children was 0.596 and 0.672 respectively,the sensitivity was 64.71%and 55.88%,respectively,and the specificity was 70.59%and 61.76%,respectively.The changes in T-wave amplitude of leads II and V_(5) had low efficacy in predicting OHT in children.The area under the curve of the change in T-wave amplitude of lead V_(6) in predicting OHT in children was 0.738,and the sensitivity and specificity were 76.47%and 67.65%,respectively.The change in T-wave amplitude of lead V_(6) had moderate efficacy for predicting OHT in children.Conclusion The changes in T-wave amplitude of lead V_(6) on the electrocardiogram image taken in the lying position relative to the standing position are of certain value in predicting OHT in children.The 12-lead electrocardiogram can provide important evidence for clinical prediction and diagnosis of OHT in children.