儿童肥厚型心肌病心室复极功能改变及临床应用价值

Changes in ventricular repolarization function of children with hypertrophic cardiomyopathy and its clinical evaluating value

目的探讨儿童肥厚型心肌病(HCM)心室复极特点及临床应用价值。方法选择2015年1月至2020年12月上海交通大学医学院附属上海儿童医学中心诊治的46例HCM患儿为HCM组,同时选择同期同院健康体检66例儿童为正常对照组,分析两组QT间期(QT)、校正后QT间期(QTc)、校正QT离散度(QTcd)、T波峰末间期(Tp-Te)、校正后Tp-Te(Tp-Tec)等相关指标。结果HCM患儿QTc、QTcd、Tp-Te、Tp-Tec及Tp-Te/QT均高于正常对照组,差异有统计学意义(t值分别为8.698、5.710、6.504、6.255、2.107,P<0.05);24小时动态心电图检查显示14例HCM患儿合并有室性心律失常,32例患儿不合并室性心律失常,HCM合并室性心律失常患者Tp-Te、Tp-Tec及Tp-Te/QT均较高,差异有统计学意义(t值分别为2.790、3.384、2.566,P<0.05);27例HCM患儿接受2个月的β受体阻滞剂治疗,结果显示用药后QTcd、Tp-Te、Tp-Tec及Tp-Te/QT均低于用药前,差异有统计学意义(t值分别为6.344、2.726、2.339、2.089,P<0.05)。结论HCM患者存在心室复极功能的明显异常,尤其Tp-Te等反映跨室壁复极离散度的指标与室性心律失常的发生密切相关,是简单、无创、有效评估HCM患者危险度及疗效的重要指标。

Objective To investigate characteristics of ventricular repolarization of children with hypertrophic cardiomyopathy(HCM)and its clinical evaluating value.Methods 46 children who were diagnosed and treated as HCM in Shanghai Children′s Medical Center Affiliated to School of Medicine,Shanghai Jiaotong University from January 2015 to December 2020 were selected as HCM group,and 66 children who received physical examination in the same hospital and over the same period were selected as normal control group.Results QT interval(QT),corrected QT interval(QTc),corrected QT dispersion(QTcd),T peak and T end period(Tp-Te),corrected Tp-Te(Tp-Tec)and other related indexes were retrospectively analyzed.QTc,QTcd,Tp-Te,Tp-Tec and Tp-Te/QT of the children with HCM were significantly longer than those in the normal control group(t=8.698,5.710,6.504,6.255 and 2.107 respectively,all P<0.05).24-hour ambulatory electrocardiogram showed that 14 children were complicated with ventricular arrhythmia and 32 children were not complicated with it.The children with HCM complicated with ventricular arrhythmia had longer Tp-Te,Tp-Tec and higher Tp-Te/QT,and the differences were statistically significant(t=2.790,3.384 and 2.566 respectively,all P<0.05).27 children with HCM were treated withβ-blocker for two months,and after the treatment,their QTcd,Tp-Te,Tp-Tec and Tp-Te/QT were shorter and lower as compared with those before the treatment,and the differences were statistically significant(t=6.344,2.726,2.339 and 2.089 respectively,all P<0.05).Conclusion The children with HCM present significant abnormalities in ventricular repolarization function.In particular,Tp-Te and other indexes reflecting transmural dispersion of repolarization are closely related to occurrence of ventricular arrhythmia.Ventricular repolarization function related indexes could be regarded as simple,noninvasive and effective indications in evaluating the risk and therapeutic effect of the children with HCM.