2020 年第 12 期 第 15 卷

川崎病患儿心率变异性指标与冠状动脉病变的关系及其对后者的预测价值

Relationship between heart rate variability and coronary artery lesions in children with Kawasaki diseases and its predictive value for the latter

作者：杨燕飞1吴玉芹1张兴2

英文作者：Yang Yanfei1 Wu Yuqin1 Zhang Xing2

单位：1昆明市儿童医院特需病区650500；2昆明市儿童医院心血管内科650500

英文单位：1Special Needs Ward Kunming Children′s Hospital Kunming 650500 China; 2Department of Cardiovascular Kunming Children′s Hospital Kunming 650500 China

关键词：川崎病；心率变异性；冠状动脉病变

英文关键词：Kawasakidisease;Heartratevariability;Coronaryarterylesions

• 摘要：

• 目的 探讨川崎病患儿心率变异性（HRV）指标与冠状动脉病变（CAL）及其严重程度的关系，以及对患儿发生CAL的预测价值。方法  选取2017年9月至2019年9月昆明市儿童医院收治的220例初发川崎病患儿，所有患儿入院后均接受超声心动图检查，评估有无CAL及CAL的严重程度，并接受24 h动态心电图监测，记录HRV指标。比较有无CAL组以及不同严重程度CAL组患儿HRV指标水平，并分析川崎病患儿发生CAL的影响因素，以及HRV指标对川崎病患儿发生CAL的预测价值。结果   220例川崎病患儿根据超声心动图检查结果分为CAL组（64例）和无CAL组（156例）,CAL组的时域指标正常窦性N-N间期标准差(SDNN)、每5分钟N-N间期平均值的标准差(SDANN)、相邻N-N间期标准差的平均值(SDNN index)、相邻N-N间期差值的均方根值(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(PNN50)和频域指标极低频功率(VLF)、低频功率(LF)、高频功率（HF）均明显低于无CAL组,LF/HF比值明显高于无CAL组（均P＜0.05）。根据CAL严重程度分为轻度CAL组（20例）、中度CAL组（24例）和重度CAL组（20例），不同严重程度CAL组患儿的SDNN、SDANN、rMSSD、VLF、LF/HF比值比较差异均有统计学意义（均P＜0.05）。Logistic回归分析结果显示，SDANN、VLF、LF/HF均为川崎病患儿发生CAL的独立影响因素（比值比=2.843、4.641、5.262,95%置信区间：2.089~7.633、2.014~9.641、3.334~7.496，均P＜0.01）。受试者工作特征曲线分析结果显示，SDANN+VLF+LF/HF比值三者联合预测川崎病患儿发生CAL的曲线下面积大于SDANN、VLF和LF/HF单独预测（0.918比0.857、0.820、0.817），且敏感度和特异度均较高（92.7%、90.4%）。结论  HRV指标中的SDANN、VLF、LF/HF比值是川崎病患儿发生CAL的独立影响因素，三者联合可提高对川崎病患儿发生CAL的预测效能，具有较高的临床诊断价值。

• Objective  To investigate the correlation between heart rate variability (HRV) and severity of coronary artery lesions(CAL) in children with Kawasaki disease(KD)，and the predictive value of CAL in children. Methods Totally 220 patients with initial KD admitted to Kunming Children′s Hospital from September 2017 to September 2019 were selected. After admission, all children received echocardiography to assess whether there was CAL or not and the severity of CAL. They were monitored by a 24-hour dynamic electrocardiogram and HRV indexes were recorded. The HRV index levels of children with or without CAL and different severity of CAL groups were compared, and the factors affecting the occurrence of CAL in children with KD were analyzed, and the predictive value of HRV indexes on the occurrence of CAL in children with KD.  Results According to the results of echocardiography, the children were divided into CAL group (64 cases) and non-CAL group(156 cases). Standard deviation of normal sinus NN interval (SDNN), standard deviation of mean N-N interval every 5 minutes (SDANN), mean standard deviation of adjacent N-N interval (SDNN index), time domain indicators, the root mean square value (rMSSD) of the difference between adjacent N-N intervals, the percentage of heartbeats with a difference of more than 50 ms between adjacent N-N intervals to the total number of heartbeats in the N-N interval (PNN50), and the frequency domain indicator extremely low frequency power (VLF), low frequency power (LF), and high frequency power (HF) in CAL group were significantly lower than those in non-CAL group, and LF/HF in CAL group was significantly higher than that in non-CAL group (all P<0.05). According to the severity of CAL, children with CAL were divided into mild CAL group (20 cases), moderate CAL group (24 cases) and severe CAL group (20 cases). The SDNN, SDANN, rMSSD, VLF, LF/HF of children with different severity of CAL groups had statistically significant differences (all P<0.01). Logistic multivariate regression analysis showed that SDANN, VLF, LF/HF were independent influencing factors of coronary artery injury in KD children (odds ratio=2.843, 4.641, 5.262, 95% confidence interval: 2.089-7.633, 2.014-9.641, 3.334-7.496, all P＜0.05). The analysis results of the subject′s receiver operating characteristic curve showed that the combined prediction of SDANN+VLF+LF/HF for the occurrence of CAL in KD children was greater than that of SDANN, VLF and LF/HF alone (0.918 vs 0.857, 0.820, 0.817), and the sensitivity and specificity were all higher (92.7%, 90.4%). Conclusions SDANN, VLF and LF/HF are independent factors influencing the occurrence of CAL in children with KD. The combination of SDANN+VLF+LF/HF can improve the predictive performance of CAL in children with KD, which has high clinical diagnostic value.