直立性高血压儿童卧位、立位心电图T波和ST段振幅变化及其临床意义
|
摘要
目的探讨直立性高血压(OHT)儿童卧位与立位心电图T波和ST段振幅变化及其临床意义。方法选取确诊为OHT患儿49例为OHT组,同期按年龄与性别匹配43例健康儿童为对照组。测量两组卧位与立位12导联心电图心率、各导联T波和ST段振幅,比较同组卧位和立位T波振幅、ST段振幅,并比较两组卧位、立位T波振幅差和ST段振幅差。结果对照组aVR、V_1、V_4～V_6导联T波振幅立位较卧位降低(P<0.05),V_4、V_5导联ST段振幅立位较卧位增加(P<0.05)。OHT组Ⅱ、aVR、aVF、V_4～V_6导联T波振幅立位较卧位降低(P<0.05),Ⅱ导联ST段振幅立位较卧位增加(P<0.05)。OHT组Ⅱ、V_6导联立位、卧位T波振幅差较对照组增大(均P<0.05)。V_6导联卧位、立位T波振幅差对OHT有诊断价值(P<0.05),V_6导联T波振幅差最佳截断值为0.105 mV,灵敏度为72.10%,特异度为57.10%。结论 V_6导联卧位、立位T波振幅差对OHT儿童具有一定的诊断价值。[中国当代儿科杂志,2019,21(7):696-700]
Objective To examine the changes in T wave and ST segment amplitude in the supine and standing electrocardiograms(ECG)of children with orthostatic hypertension(OHT)and to determine their clinical significance.Methods A total of 49 children with OHT were included in the OHT group.Forty-three age-and sex-matched healthy children were included in the control group.Heart rate and T wave and ST segment amplitude were measured in both groups.T wave amplitude and ST segment amplitude in supine ECG were compared with those in standing ECG within each group.The differences in supine vs standing T wave amplitude and ST segment amplitude were compared between the OHT and control groups.Results In the control group,T wave amplitude in leads aVR,V_1,and V_4-V_6 were significantly lower in standing ECG than in supine ECG(P<0.05);ST segment amplitude in leads V_4 and V_5 were significantly higher in standing ECG than in supine ECG(P<0.05).In the OHT group,T wave amplitude in leads II,aVR,aVF,and V_4-V_6 were significantly lower in standing ECG than in supine ECG(P<0.05);ST segment amplitude in lead Ⅱ was significantly higher in standing ECG than in supine ECG(P<0.05).The differences in T wave amplitude in lead Ⅱ and V_6 between supine and standing ECG were significantly higher in the OHT group than in the control group(P<0.05).Difference in T wave amplitude in lead V_6 between supine and standing ECG was a significant diagnostic marker for OHT(P<0.05).This marker had 72.10%sensitivity and 57.10%specificity for the diagnosis of OHT at the optimal cut-off value of 0.105 mV.Conclusions Difference in T wave amplitude in lead V_6 between supine and standing ECG has certain diagnostic value for OHT.[Chin J Contemp Pediatr,2019,21(7):696-700]
Objective To examine the changes in T wave and ST segment amplitude in the supine and standing electrocardiograms(ECG)of children with orthostatic hypertension(OHT)and to determine their clinical significance.Methods A total of 49 children with OHT were included in the OHT group.Forty-three age-and sex-matched healthy children were included in the control group.Heart rate and T wave and ST segment amplitude were measured in both groups.T wave amplitude and ST segment amplitude in supine ECG were compared with those in standing ECG within each group.The differences in supine vs standing T wave amplitude and ST segment amplitude were compared between the OHT and control groups.Results In the control group,T wave amplitude in leads aVR,V_1,and V_4-V_6 were significantly lower in standing ECG than in supine ECG(P<0.05);ST segment amplitude in leads V_4 and V_5 were significantly higher in standing ECG than in supine ECG(P<0.05).In the OHT group,T wave amplitude in leads II,aVR,aVF,and V_4-V_6 were significantly lower in standing ECG than in supine ECG(P<0.05);ST segment amplitude in lead Ⅱ was significantly higher in standing ECG than in supine ECG(P<0.05).The differences in T wave amplitude in lead Ⅱ and V_6 between supine and standing ECG were significantly higher in the OHT group than in the control group(P<0.05).Difference in T wave amplitude in lead V_6 between supine and standing ECG was a significant diagnostic marker for OHT(P<0.05).This marker had 72.10%sensitivity and 57.10%specificity for the diagnosis of OHT at the optimal cut-off value of 0.105 mV.Conclusions Difference in T wave amplitude in lead V_6 between supine and standing ECG has certain diagnostic value for OHT.[Chin J Contemp Pediatr,2019,21(7):696-700]
引文
[1]Streeten DH,Auchincloss JH Jr,Anderson GH Jr,et al.Orthostatic hypertension.Pathogenetic studies[J].Hypertension,1985,7(2):196-203.
[2]Nibouche-Hattab WN,Lanasri N,Zeraoulia F,et al.Orthostatic hypertension in normotensive type 2 diabetics:what characteristics?[J].Ann Cardiol Angeiol(Paris),2017,66(3):159-164.
[3]Bhuachalla BN,McGarrigle CA,O'Leary N,et al.Orthostatic hypertension as a risk factor for age-related macular degeneration:evidence from the Irish longitudinal study on ageing[J].Exp Gerontol,2018,106:80-87.
[4]赵娟,杨锦艳,金红芳,等.儿童直立性高血压的临床特征[J].中华儿科杂志,2012,50(11):839-842.
[5]王成,邹润梅.儿童直立性高血压研究进展[J].中华实用儿科临床杂志,2014,29(1):2-5.
[6]中华医学会儿科学分会心血管学组,《中华儿科杂志》编辑委员会,北京医学会儿科学分会心血管学组,等.儿童晕厥诊断指南(2016年修订版)[J].中华儿科杂志,2016,54(4):246-250.
[7]Chu W,Wang C,Lin P,et al.Transient aphasia:a rare complication of head-up tilt test[J].Neurol Sci,2014,35(7):1127-1132.
[8]李雯,王成,吴礼嘉,等.直立倾斜试验阳性反应出现后的心律失常特征[J].中华心血管病杂志,2010,38(9):805-808.
[9]冉静,王成.卧位、立位心电图对心血管自主神经功能的评价[J].国际心血管病杂志,2014,41(2):104-106.
[10]林治湖,张树龙.自主神经与心电图波形[J].临床心电学杂志,2008,17(4):257-258.
[11]Wang C,Li Y,Liao Y,et al.2018 Chinese Pediatric Cardiology Society(CPCS)guideline for diagnosis and treatment of syncope in children and adolescents[J].Sci Bull,2018,63(23):1558-1564.
[12]王圆圆,李红霞,王瑜丽,等.儿童直立性高血压的临床观察性研究[J].中华高血压杂志,2018,26(1):46-50.
[13]Koskinen J,Juonala M,Dwyer T,et al.Utility of different blood pressure measurement components in childhood to predict adult carotid intima-media thickness[J].Hypertension,2019,73(2):335-341.
[14]叶雅致.不同体位心电图ST-T改变分析[J].实用心脑肺血管病杂志,2011,19(8):1356.
[15]李智.血管迷走性昏厥儿童卧位,立位心电图导联T波振幅变化的临床意义[J].中国医药指南,2013,11(11):152.
[16]李云利,王成,李芳,等.不明原因胸闷痛静息期儿童卧位与立位心电图T波及ST段振幅变化的临床意义[J].中国当代儿科杂志,2013,15(9):771-774.
[17]王玉汶,许毅,李芳,等.儿童青少年体位性心动过速综合征卧位与立位心电图T波及ST段振幅变化[J].中国小儿急救医学,2018,25(9):661-667,672.
[2]Nibouche-Hattab WN,Lanasri N,Zeraoulia F,et al.Orthostatic hypertension in normotensive type 2 diabetics:what characteristics?[J].Ann Cardiol Angeiol(Paris),2017,66(3):159-164.
[3]Bhuachalla BN,McGarrigle CA,O'Leary N,et al.Orthostatic hypertension as a risk factor for age-related macular degeneration:evidence from the Irish longitudinal study on ageing[J].Exp Gerontol,2018,106:80-87.
[4]赵娟,杨锦艳,金红芳,等.儿童直立性高血压的临床特征[J].中华儿科杂志,2012,50(11):839-842.
[5]王成,邹润梅.儿童直立性高血压研究进展[J].中华实用儿科临床杂志,2014,29(1):2-5.
[6]中华医学会儿科学分会心血管学组,《中华儿科杂志》编辑委员会,北京医学会儿科学分会心血管学组,等.儿童晕厥诊断指南(2016年修订版)[J].中华儿科杂志,2016,54(4):246-250.
[7]Chu W,Wang C,Lin P,et al.Transient aphasia:a rare complication of head-up tilt test[J].Neurol Sci,2014,35(7):1127-1132.
[8]李雯,王成,吴礼嘉,等.直立倾斜试验阳性反应出现后的心律失常特征[J].中华心血管病杂志,2010,38(9):805-808.
[9]冉静,王成.卧位、立位心电图对心血管自主神经功能的评价[J].国际心血管病杂志,2014,41(2):104-106.
[10]林治湖,张树龙.自主神经与心电图波形[J].临床心电学杂志,2008,17(4):257-258.
[11]Wang C,Li Y,Liao Y,et al.2018 Chinese Pediatric Cardiology Society(CPCS)guideline for diagnosis and treatment of syncope in children and adolescents[J].Sci Bull,2018,63(23):1558-1564.
[12]王圆圆,李红霞,王瑜丽,等.儿童直立性高血压的临床观察性研究[J].中华高血压杂志,2018,26(1):46-50.
[13]Koskinen J,Juonala M,Dwyer T,et al.Utility of different blood pressure measurement components in childhood to predict adult carotid intima-media thickness[J].Hypertension,2019,73(2):335-341.
[14]叶雅致.不同体位心电图ST-T改变分析[J].实用心脑肺血管病杂志,2011,19(8):1356.
[15]李智.血管迷走性昏厥儿童卧位,立位心电图导联T波振幅变化的临床意义[J].中国医药指南,2013,11(11):152.
[16]李云利,王成,李芳,等.不明原因胸闷痛静息期儿童卧位与立位心电图T波及ST段振幅变化的临床意义[J].中国当代儿科杂志,2013,15(9):771-774.
[17]王玉汶,许毅,李芳,等.儿童青少年体位性心动过速综合征卧位与立位心电图T波及ST段振幅变化[J].中国小儿急救医学,2018,25(9):661-667,672.