摘要
目的探讨川崎病（KD）患儿急性期心率变异性（HRV）与降钙素原（PCT）、超敏C反应蛋白（hs—CRP）及红细胞沉降率（ESR）的相关性，及其对KD尤其是不完全川崎病（iKD）诊断及预后判断中的应用价值。方法选取成都市妇女儿童中心医院2012年8月至2015年10月收治的KD患儿220例，根据诊断标准将KD患儿分为典型KD组与iKD组，根据有无冠状动脉损害将KD患儿分为无冠状动脉损害组（NCAL组）与冠状动脉损害组（CAL组），选取同期100例健康儿童为健康对照组。测定KD患儿急性期和健康儿童血清PCT、hs—CRP及ESR水平，并行长程HRV指标分析，比较CAL组与NCAL组、典型KD组与iKD组HRV、PCT、hs—CRP及ESR的差异，分析HRV与PCT、hs—CRP及ESR的相关性。结果220例KD患者中典型KD组182例，iKD组38例；CAL组64例，NCAL组156例。KD患者HRV较健康对照组均明显下降（均P〈0．05），以CAL组HRV下降更明显，其中正常窦性N—N间期标准差（SDNN）、相邻NN间期之差〉50ms的心搏数占心搏总数的百分数（PNN50）及低频功率（LF）在CAL组、NCAL组与健康对照组间差异均有统计学意义（均P〈0．05）。典型KD组与iKD组HRV指标、PCT、hs—CRP水平差异均无统计学意义（均P〉0．05），ESR水平差异有统计学意义（P〈0．05）。SDNN与PCT、hs—CRP、ESR均呈负相关（r=-0．443、-0．364、-0．427，均P〈0．05）。结论KD患儿急性期HRV明显下降与其炎性反应有-定相关性，HRV对KD并冠状动脉损害判断具有-定的临床应用价值，但尚未发现其有助于iKD的早期诊断。
Objective To investigate the relationship of heart rate variability （HRV） and procalcitonin （PCT） , high sensitivity C - reactive protein （ hs - CRP） and erythrocyte sedimentation rate （ESR） in children with Ka- wasaki disease （KD） in the acute stage ,and to investigate their value in diagnosis and prognosis of KD especially in- complete KD （iKD）. Methods Two hundred and twenty patients with KD in Chengdu Women and Children＇s Central Hospital from August 2012 to October 2015 were selected. According to the diagnostic criteria, patients with KD were divided into a typical KD group and an iKD group. According to the status of coronary artery damage, the patients with KD were divided into coronary artery lesion （CAL） group and no coronary artery lesion（NCAL） group. Another 100 healthy children were selected as healthy control group. All the children received 24 h dynamic electrocardiogram and were given tests of blood PCT,hs - CRP and ESR. The differences of HRV,PCT,hs - CRP and ESR between the CAL group and the NCAL group, between the typical KD group and iKD group were compared. The correlations of HRV and PCT, hs -CRP and ESR were analyzed. Results Of 220 KD patients, 182 cases were in the typical KD group and 38 cases in the iKD group;64 cases in the CAL group and 156 cases in the NCAL group. The mean levels of HRV were lower in KD group than those in healthy control group（ all P 〈 0.05 ） , especially those in the CAL group fell more obviously. The differences in the standard deviation of N - N intervals （ SDNN ）, percent ages of N - N 50 in the total number N - N intervals （PNNS0） and low frequency （LF） between the CAL group, the NCAL group and the healthy control group were all statistically significant（ all P 〈 0.05 ）. The mean levels of HRV, PCT and hs - CRP had no statistically significant difference between typical KD and iKD groups （ all P 〉 0.05 ）. The mean level of ESR had a statisticaliy sig- nificant difference between 2 groups（P 〈0.05）. SDNN was negatively correlated with PCT, hs -CRP and ESR （r = - 0.443, - 0.364, - 0.427, all P 〈 0.05）. Conclusion In patients with KD in the acute stage,the decrease of HRV can be correlated with inflammatory reaction. HRV can be used as valuable predictors for coronary artery lesion in pa- tients with KD, but its help in the early diagnosis of iKD has not found.
作者
陈婷婷
石坤
柳颐龄
杨艳峰
李焰
王献民
Chen Tingting;Shi Kun;Liu Yiling;Yang Yanfeng;Li Yan;Wang Xianrnin(Department of Cardiology, Chengdu Women and Children＇s Central Hospital, Chengdu 610091, China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2017年第21期1657-1660,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
四川省卫计委科研项目（120515）
成都市卫计委科研项目（2015133）
关键词
川崎病
心率变异性
降钙素原
超敏C反应蛋白
红细胞沉降率
Kawasaki disease
Heart rate variability
Procalcitonin
High sensitivity C - reactive protein
Erythrocyte sedimentation rate
