心电图特征及其参数对肺炎支原体肺炎患儿并发心肌损害的预测价值

Predictive value of electrocardiographic characteristics and parameters for myocardial damage in children with Mycoplasma pneumoniae pneumonia

目的探讨心电图特征及其参数低频功率与高频功率比值(LF/HF)、QT离散度(QTd)、震荡起始(TO)、震荡斜率(TS)对肺炎支原体肺炎(MPP)患儿并发心肌损害的预测价值。方法选择2020年5月至2023年5月西北妇女儿童医院收治的MPP患儿151例为研究对象。根据是否并发心肌损害将患儿分为损害组(n=45)和未损害组(n=106)。比较2组患儿临床资料,采用Pearson相关分析心电图特征及参数与心肌酶谱指标的相关性,采用logistic回归分析MPP患儿并发心肌损害的影响因素,采用受试者操作特征(ROC)曲线分析心电图特征及各参数对MPP患儿并发心肌损害的预测价值。结果2组患儿的年龄、性别、肺部湿啰音、肺部喘鸣音、呕吐腹泻比较差异无统计学意义(P>0.05);损害组患儿发热程度、阵发性痉挛性咳嗽、肺部片状浸润影比例、心电图特征异常率、QTd、TO及血清乳酸脱氢酶(LDH)、肌酸激酶(CK)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶同工酶MB(CK-MB)水平显著高于未损害组,LF/HF、TS显著低于未损害组(P<0.05)。心电图特征异常、QTd、TO与LDH、CK、α-HBDH、CK-MB呈正相关(P<0.05),LF/HF、TS与LDH、CK、α-HBDH、CK-MB呈负相关(P<0.05)。Logistic回归分析结果显示,将发热程度、阵发性痉挛性咳嗽、肺部片状浸润影等因素进行校正后,心电图特征异常、QTd、TO、LF/HF、TS仍与MPP患儿并发心肌损害独立相关(P<0.05)。ROC曲线分析结果显示,心电图特征、QTd、TO、LF/HF、TS单独及联合预测MPP患儿并发心肌损害的曲线下面积分别为0.808、0.817、0.770、0.792、0.731、0.937,敏感度分别为88.89%、71.11%、66.67%、68.89%、82.22%、80.00%,特异度分别为72.64%、85.85%、76.42%、77.36%、59.43%、94.34%,各指标联合检测对MPP患儿并发心肌损害的预测价值大于各参数单独预测。结论心电图特征及其参数LF/HF、QTd、TO、TS可作为MPP患儿并发心肌损害的预测指标,且联合预测价值更高。

Objective To explore the predictive value of electrocardiographic characteristics and parameters such as the ratio of low-frequency power to high-frequency power(LF/HF),QT dispersion(QTd),turbulence oscillation(TO)and turbulence slope(TS)for myocardial damage in children with Mycoplasma pneumoniae pneumonia(MPP).Methods A total of 151 children with MPP admitted to the Northwest Women's and Children's Hospital from May 2020 to May 2023 were selected as the research subjects.The children were divided into damage group(n=45)and non-damage group(n=106)according to whether they were complicated with myocardial damage.The clinical data of children between the two groups were compared.The correlation between electrocardiographic characteristics and parameters and myocardial enzyme spectrum indicators was analyzed by using Pearson correlation coefficient.Logistic regression was used to analyze the influencing factors of myocardial damage in children with MPP.The predictive value of electrocardiographic characteristics and parameters for myocardial damage in children with MPP was analyzed by using the receiver operating characteristic(ROC)curve.Results There was no statistically significant difference in age,gender,lung wet rale,lung stridor,vomiting and diarrhea of children between the two groups(P>0.05).The degree of fever,paroxysmal spasmodic cough,proportion of lung patchy infiltrative shadows,rate of abnormal electrocardiographic characteristics,QTd,TO,serum lactate dehydrogenase(LDH),creatine kinase(CK),α-hydroxybutyrate dehydrogenase(α-HBDH),and creatine kinase-MB(CK-MB)levels in the damage group were significantly higher than those in the non-damage group,while the LF/HF and TS were significantly lower than those in the non-damage group(P<0.05).The abnormal electrocardiographic characteristics,QTd and TO were positively correlated with LDH,CK,α-HBDH,and CK-MB(P<0.05);while the LF/HF and TS were negatively correlated with LDH,CK,α-HBDH,and CK-MB(P<0.05).The logistic regression analysis showed that after adjusting for factors such as fever severity,paroxysmal spasmodic cough and lung patchy infiltrative shadows,abnormal electrocardiographic characteristics,QTd,TO,LF/HF,and TS were still independently associated with myocardial damage in children with MPP(P<0.05).The results of ROC curve analysis showed that the areas under the curve for electrocardiographic characteristics,QTd,TO,LF/HF,TS,and their combination in predicting myocardial damage in children with MPP were 0.808,0.817,0.770,0.792,0.731,and 0.937,respectively;the sensitivities were 88.89%,71.11%,66.67%,68.89%,82.22%,and 80.00%,respectively;and the specificities were 72.64%,85.85%,76.42%,77.36%,59.43%,and 94.34%,respectively.The predictive value of the combination for myocardial damage in children with MPP was greater than that of individual parameters.Conclusion The electrocardiographic characteristics and parameters such as LF/HF,QTd,TO,and TS can be used as predicting indicators for myocardial damage in children with MPP,and the predictive value of their combination is even higher.