目的:该研究通过对重型β-地中海贫血(β-TM)患儿心率变异性(HRV)的变化特点的研究,探讨HRV对β-TM患儿心功能异常的诊断价值。方法:对21例β-TM患儿(地贫组)和15例正常儿童(对照组)分别进行24 h动态心电图(Holter)检查,比较分析两组HRV时域和频域指标的变化及β-TM患儿血清铁蛋白水平与HRV的相关性。结果:地贫组患儿HRV时域指标SDNN、rMSSD、pNN50 和频域指标极低频谱(VLF)、低频谱(LF)、高频谱(HF)均降低,与对照组比较差异有统计学意义(P<0.05);血清铁蛋白水平与HRV的变化无相关性。结论:β-TM患儿自主神经功能异常;HRV对β-TM患儿早期心功能异常有预测价值。
Abstract
OBJECTIVE: To study the diagnostic value of heart rate variability (HRV) in heart dysfunction in children with beta-thalassemia major (β-TM)by examining the changes of HRV in β-TM children. METHODS: A 24 hours Holter monitoring electrocardiogram (Holter) was performed in 21 children with β-TM and 15 healthy children (control group). The time domain and frequency domain indexes of HRV in the two groups were compared. The correlation between serum ferritin levels and HRV was evaluated. RESULTS: The time domain indexes SDNN, rMSSD and PNN50 and the frequency domain indexes very low frequency (VLF), low frequency (LF) and high frequency (HF) in the β-TM group were significantly lower than in the control group (P<0.05). There was no correlation between serum ferritin level and HRV in children with β-TM. CONCLUSIONS: The autonomic nerve dysfunction exists in children with β-TM. HRV analysis is useful in the prediction of early cardiac dysfunction in children with β-TM.
关键词
β-地中海贫血 /
心率变异性 /
血清铁蛋白 /
儿童
Key words
Beta-thalassemia /
Heart rate variability /
Serum ferritin /
Child
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参考文献
[1]De Chiara B, Crivellaro W, Sara R, Ruffini L, Parolini M, Fesslov-V, et al. Early detection of cardiac dysfunction in thalassemic patients by radionuclide angiography and heart rate variability analysis[J]. Eur J Haematol, 2005, 74(6): 517-522.
[2]鲍敏,刘玉红.心率变异性与心血管疾病预后的判断[J].吉林医学,2008,29(21):1959-1962.
[3]张新华,黄有文.珠蛋白生成障碍性贫血[M]//张之南.血液病诊断及疗效标准.第3版.北京:科学出版社,2007:29-35.
[4]丁天凌,陈勤奋.输血依赖性铁过载的评估及治疗进展[J].中国输血杂志,2010,23(6):421-423.
[5]Beutler E, Hoffbrand AV, Cook JD. Iron deficiency and overload[J]. Hematology Am Soc Hematol Educ Program, 2003: 40-61.
[6]朱俏萍,黄建华,李芳平.心肌梗死急性期心脏自主神经变化与猝死的相关性探讨[J].实用心电学杂志,2007,16(3):191-192.
[7]何海英,周飞鸥.心率变异性在慢性心力衰竭患者中的临床意义[J].现代实用医学,2010,22(3):280-281.
[8]邓丽萍,赵皎.小儿心肌炎的心率变异性[J].现代电生理学杂志,2003,10(2):71-72.
[9]张开.临床心电信息学[M].长沙:湖南科学技术出版社,2002:582-583.
[10]郑慧芬,王成,谢振武.自主神经在儿童生长发育中的变化及其研究进展[J].国外医学·儿科学分册,2005,32(5):265-267.
[11]王锐,师廷明,普平,曾雁云,李红玲.儿童心肌炎动态心电图监测临床价值探讨[J].中国当代儿科杂志,2007,9(3):213-215.
[12]Gurses D, Ulger Z, Levent E, Aydinok Y, Ozyurek AR. Time domain heart rate variability analysis in patients with thalassaemia major[J]. Acta Cardiol, 2005, 60(5):477-481.
[13]Kardelen F, Tezcan G, Akcurin G, Ertug H, Yesilipek A. Heart rate variability in patients with thalassemia major[J]. Pediatr Cardiol, 2008, 29(5):935-939.