儿童病毒性心肌炎动态心电图变化及其临床意义

Changes and clinical significance of dynamic electrocardiogram in children with viral myocarditis

目的探究动态心电图变化在病毒性心肌炎(VMC)患儿心肌受损程度评估及治疗中的临床应用价值。方法选取2017年9月至2020年9月延安市人民医院收治的VMC患儿120例,于治疗前及治疗结束后进行动态心电图检查,比较治疗前后患儿的异常心电图检出率、动态心电图指标[心率变异性低频指标(LF)、心率变异性高频指标(HF)、低频与高频比值(LF/HF)、24 h内全部正常窦性心搏间期标准差(SDNN)、每5 min时间段内正常窦性心搏间期标准差(SDANN)、全部相邻窦性心搏间期差值均方根(RMSSD)]、心肌肌钙蛋白Ⅰ(cTnⅠ)及心肌酶[肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)]水平,并采用Pearson相关检验分析动态心电图心率变异性指标与cTnⅠ及心肌酶的相关性。结果治疗前VMC患儿动态心电图异常率为93.33%,治疗结束后异常率为9.17%,差异有统计学意义(P<0.05);治疗结束后VMC患儿的早搏次数明显低于治疗前[(468.25±106.47)次/d vs(936.71±143.05)次/d],差异有统计学意义(P<0.05);治疗结束后VMC患儿的动态心电图指标LF、HF、RMSSD、SDANN以及SDNN[(686.46±43.52)Hz、(472.70±36.45)Hz、(51.39±11.86)ms、(120.03±21.79)ms和(125.57±20.26)ms]明显高于治疗前[(624.88±39.45)Hz、(347.71±33.37)Hz、(45.72±8.95)ms、(106.55±24.21)ms和(110.31±16.40)ms],LF/HF明显低于治疗前[(1.45±0.14)%vs(1.80±0.12)%],差异均有统计学意义(P<0.05);治疗结束后VMC患儿的cTnⅠ、CK-MB、CK水平分别为(0.35±0.09)mg/L、(17.78±3.42)U/L和(104.46±13.11)U/L,明显低于治疗前的(0.51±0.11)mg/L、(30.96±4.15)U/L和(218.12±20.57)U/L,差异均有统计学意义(P<0.05);pearson相关检验结果显示,动态心电图心率变异性指标与cTnⅠ、CK-MB、CK均呈显著负相关(P<0.01)。结论动态心电图变化可用于评估VMC患儿治疗情况,分析VMC患儿动态心电图变化,有利于对患儿心肌受损程度进行尽早评估,及时采取针对性治疗手段,具有一定临床应用价值。

Objective To explore the clinical application value of dynamic electrocardiogram changes in the evaluation and treatment of myocardial damage degree in children with viral myocarditis(VMC).Methods A total of 120 children with VMC who were admitted to Yan'an People's Hospital from September 2017 to September 2020 were selected for dynamic electrocardiogram examination before treatment and after the end of treatment.The abnormal elec-trocardiogram detection rate,dynamic electrocardiogram indicators[heart rate variability low frequency index(LF),heart rate variability high frequency index(HF),ratio of low frequency to high frequency(LF/HF),standard deviation of normal number of intervals(SDNN)within 24 h,standard deviation of per 5 min averages normal number of intervals(SDANN),root mean square value of standard deviation between adjacent normal number of intervals(RMSSD)],cardi-ac troponinⅠ(cTnⅠ),and myocardial enzymes[creatine kinase isoenzyme(CK-MB),creatine kinase(CK)]were com-pared before and after treatment.Pearson correlation test was used to analyze the correlation between heart rate variabili-ty indicators of dynamic electrocardiogram and cTnⅠ,myocardial enzymes.Results The abnormal rate of dynamic electrocardiogram in children with VMC before treatment was 93.33%,which was significantly higher than 9.17%after treatment(P<0.05).The number of premature beats after treatment was significantly lower than that before treatment:(468.25±106.47)times/d vs(936.71±143.05)times/d,P<0.05.The dynamic electrocardiogram indicators of LF,HF,RMSSD,SDANN,and SDNN were(686.46±43.52)Hz,(472.70±36.45)Hz,(51.39±11.86)ms,(120.03±21.79)ms,and(125.57±20.26)ms in children with VMC after treatment,which were significantly higher than(624.88±39.45)Hz,(347.71±33.37)Hz,(45.72±8.95)ms,(106.55±24.21)ms,and(110.31±16.40)ms before treatment(P<0.05),while the LF/HF was(1.45±0.14)%after the treatment,significantly lower than(1.80±0.12)%before treatment(P<0.05).After treatment,the levels of cTnⅠ,CK-MB,and CK were(0.35±0.09)mg/L,(17.78±3.42)U/L,and(104.46±13.11)U/L in children with VMC,significantly lower than(0.51±0.11)mg/L,(30.96±4.15)U/L,and(218.12±20.57)U/L before treat-ment(P<0.05).According to Pearson correlation test,heart rate variability indicators of dynamic electrocardiogram were significantly negatively correlated with cTnⅠ,CK-MB,and CK(P<0.01).Conclusion Dynamic electrocardiogram changes can be used to evaluate the treatment of children with VMC.Analysis of dynamic electrocardiogram changes in children with VMC is helpful for early assessment of degree of myocardial damage and timely targeted treatment,which has a certain clinical application value.