心率变异性指标和中性粒细胞与淋巴细胞比值对小儿川崎病并发冠状动脉病变的诊断价值

Diagnostic value of heart rate variability indicators and neutrophil-to-lymphocyte ratio in children with Kawasaki disease with coronary artery lesions

目的探讨心率变异性(heart rate variability,HRV)指标和中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)对小儿川崎病并发冠状动脉病变(coronary artery lesion,CAL)的诊断价值。方法选取2017年9月至2019年9月昆明市儿童医院收治的220例初发川崎病急性期患儿为研究对象,选取同时期来院体检的健康儿童100例作为对照组。根据超声心动图检查结果,将患儿分为CAL组(n=64)和无CAL组(n=156)。检测白细胞计数(white blood cell,WBC)、中性粒细胞计数(neutrophil count,NEU)、淋巴细胞计数(lymphocyte count,LYM)、C反应蛋白(C-reactive protein,CRP)水平,计算NLR。采用24 h动态心电图记录HRV指标:①时域指标:正常窦性N-N间期标准差(standard deviation in N-N intervals,SDNN)、相邻N-N间期标准差平均值(SDNN index)、每5分钟N-N间期平均值标准差(5 min N-N interval mean standard deviation,SDANN)、相邻N-N间期差值的均方根值(root mean square of sussessive differences,rMSSD),相邻N-N间期之差超过50 ms的心搏数占N-N间期心搏总数的百分数(percentage of N-Nintervals over 50 msec different from preceding interval,PNN50)等;②频域指标:极低频功率(very low frequency,VLF,0.003~0.040 Hz),低频功率(low frequency,LF,0.04~0.15 Hz),高频功率(high frequency,HF,0.15~0.40 Hz),低频与高频的比值(LF/HF)。统计学方法采用单因素方差分析、独立样本t检验、χ^(2)检验、Logistic多因素回归分析、受试者工作特征(receiveroperating characteristic curve,ROC)曲线。结果CAL组、无CAL组与对照组的WBC[(16.2±6.2)、(14.5±5.7)与(6.9±2.4)×10^(9)/L]、NEU[(13.7±5.0)、(10.0±4.6)与(3.9±1.3)×10^(9)/L]、LYM[(4.0±2.2)、(3.6±2.1)与(2.2±0.4)×10^(9)/L]、NLR(4.5±5.1、3.1±2.6、1.6±1.1)、CRP[(37.7±6.8)、(23.5±4.8)与(5.5±1.2)mg/L],CAL组和无CAL组均高于对照组,CAL组高于无CAL组(P值均<0.05)。CAL组、无CAL组与对照组的HRV时域指标SDNN[(78±22)、(93±37)与(97±36)ms]、SDANN[(70±33)、(79±30)与(83±34)ms]、SDNN index[(45±20)、(49±17)与(52±21)ms]、rMSSD[(38±22)、(41±30)与(50±22)ms]、PNN50[(10±7)%、(13±10)%与(14±13)%],无CAL组和对照组高于CAL组,无CAL组高于CAL组(P值均<0.05)。CAL组、无CAL组与对照组的HRV频域指标VLF[(1011±443)、(1246±597)与(1548±874)ms2]、LF[(177±115)、(294±167)与(544±238)ms2]、HF[(111±93)、(174±123)与(353±253)ms2]、LF/HF[(2.4±1.3)、(2.1±1.0)与(1.5±0.6)]比较,CAL组和无CAL组的SDNN、SDANN、SDNN index、rMSSD、PNN50、VLF、LF、HF均低于对照组,LF/HF均高于对照组,CAL组的SDNN、SDANN、SDNN index、rMSSD、PNN50、VLF、LF、HF均低于无CAL组,LF/HF高于无CAL组(P值均<0.05)。多因素Logistic回归分析结果显示WBC、NLR、CRP、SDNN、SDANN、VLF、LF/HF是引起CAL的独立影响因素(OR值分别为3.128、3.128、1.716、2.262、2.843、1.596、5.262,P值均<0.05)。ROC曲线分析显示HRV、NLR对川崎病患儿并发CAL具有较高的诊断价值。结论HRV、NLR二者联用对提高川崎病患儿发生CAL的预测有很好的临床诊断价值。

Objective To investigate the diagnostic value of heart rate variability(HRV)and neutrophil-to-lymphocyte ratio(NLR)in children with Kawasaki disease with coronary artery lesions(CAL).Method From September 2017 to September 2019,220 children with acute Kawasaki disease who were admitted to Kunming Children's Hospital were selected as the research objects,and 100 healthy children who came to the hospital for physical examination were server as the control group.The children were divided into CAL group(n=64)and non-CAL group(n=156)by the the results of echocardiography coronary examination.The levels of white blood cell(WBC),neutrophil count(NEU),lymphocyte count(LYM),and C-reactive protein(CRP)were detected,and NLR was calculated.HRV indicators were recorded by 24-hour Holter ECG:①Time domain indicators:standard deviation in N-N Intervals(SDNN),SDNN index,5 min N-N interval mean standard deviation(SDANN),root mean square of sussessive differences(rMSSD),percentage of N-N intervals over 50 ms different from preceding interval(PNN50).②Frequency domain index:very low frequency(VLF,0.003-0.040 Hz),low frequency(LF,0.04-0.15 Hz),high frequency(HF,0.15-0.40 Hz),the ratio of LF/HF.Statistical methods performed by One-way analysis of variance,independent samples t test,χ^(2) test,Logistic multivariate regression analysis,receiver operating characteristic curve(ROC).Result The values of WBC in CAL group,non-CAL group and the control group were as follows:[(16.2±6.2)×10^(9)/L,(14.5±5.7)×10^(9)/L and(6.9±2.4)×10^(9)/L].NEU were[(13.7±5.0)×10^(9)/L,(10.0±4.6)×10^(9)/L and(3.9±1.3)×10^(9)/L].LYM were[(4.0±2.2)×10^(9)/L,(3.6±2.1)×10^(9)/L and(2.2±0.4)×10^(9)/L].NLR were(4.5±5.1,3.1±2.6,1.6±1.1).CRP were[(37.7±6.8),(23.5±4.8)and(5.5±1.2)mg/L].CAL group and non-CAL group were higher than those in the control group,CAL group were higher than those in the non-CAL group(all P<0.05).HRV time domain indicators SDNN in CAL group,non-CAL group and the control group were as follows:[(78±22),(93±37)and(97±36)ms].SDANN were[(70±33),(79±30)and(83±34)ms].SDNN index were[(45±20),(49±17)and(52±21)ms].rMSSD were[(38±22),(41±30)and(50±22)ms],PNN50 were[(10±7)%,(13±10)%and(14±13)%].Non-CAL group and the control group were higher than those in the CAL group,and the CAL group was lower than that in the non-CAL group(all P<0.05).HRV frequency domain indicators in CAL group,non-CAL group and the control group were as follows:VLF[(1011±443),(1246±597)and(1548±874)ms2],LF[(177±115),(294±167)and(544±238)ms2],HF[(111±93),(174±123)and(353±253)ms2],LF/HF[(2.4±1.3),(2.1±1.0)and(1.5±0.6)].The SDNN,SDANN,SDNN index,rMSSD,PNN50,VLF,LF,and HF of CAL group and non-CAL group were lower than those in the control group,and LF/HF were higher than those in the control group.The rMSSD,PNN50,VLF,LF,and HF were all lower than those in the non-CAL group,and LF/HF were higher than those in the non-CAL group(all P<0.05).Logistic multivariate regression analysis showed that WBC,NLR,CRP,SDNN,SDANN,VLF,LF/HF were independent influencing factors of CAL in cases with Kawasaki disease(OR values were 3.128,3.128,1.716,2.262,2.843,1.596,5.262,P<0.05).ROC curve analysis showed that HRV and NLR had high diagnostic value for CAL in children with Kawasaki disease.Conclusion Combination of HRV and NLR can improve the predictive performance of CAL in children with Kawasaki disease,and has good clinical use.