代谢综合征少年心率减速力对自主神经 功能失衡的评估价值

Evaluation value of heart rate deceleration capacity on autonomic nervous dysfunction in juveniles with metabolic syndrome

摘要:

目的 探讨心率减速力（DC）对评估代谢综合征（MS）少年自主神经功能失衡的价值。方 法 选取2014 年1 月-2015 年5 月纳入10 ～ 16 岁少年MS 初诊患者100 例为观察组，年龄匹配的健康志愿 者100 例为对照组。应用24 h 动态心电图分析心率变异性（HRV）和DC ；根据DC 值将MS 患者划分为 DC ≥ 4.5 ms 组（低危组）、DC 值2.6 ～ 4.4 ms 组（中危组）、DC 值≤ 2.5 ms 组（高危组），随访至少24 个月， 比较随访前后各组空腹血糖（FBG）、空腹胰岛素（FINS）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）、 总胆固醇（TC）、血清尿酸（UA）、血钙水平。结果 观察组DC 及HRV 各指标与对照组比较，均差异有统 计学意义（P <0.05），观察组低于对照组。DC 与HRV 各指标均呈正相关（P <0.05）。随访24 个月时，高危 组FBG、FINS、TG、TC、UA 与中危组和低危组比较，差异有统计学意义（P <0.05），高危组均高于中危组 和低危组。结论 MS 少年多伴DC 异常降低，且其变化与早期HRV 相关指标异常有关；DC 异常高危组随 访期间出现自主神经功能失衡风险更大。

Abstract:

Objective To investigate the value of heart rate deceleration capacity (DC) in assessing the autonomic nervous system dysfunction in juveniles with metabolic syndrome (MS). Methods Totally 100 juvenile aged 10 to 16 years who were first time diagnosed as MS from January 2014 to May 2015 were involved as the observation group, meanwhile 100 healthy volunteers whose sex and age were matched were involved as the control group. The DC and heart rate variability (HRV) were detected in all cases. Children in the observation group were further divided into 3 subgroups, the cases with DC ≥ 4.5 ms were included as low-risk group, those with DC of 2.6- 4.5 ms were included as mid-risk group, and those with DC ≤ 2.5 ms were included as high-risk group. All cases were followed up for at least 24 months, the changes in fasting blood glucose (FBG), fasting insulin (FINS), highdensity lipoprotein cholesterol (HDL-C), triglyceride (TG), total cholesterol (TC), serum uric acid (UA) and blood calcium were compared. Results DC and HRV indexes in the observation group were much lower than those in the control group (P < 0.05). There were positive correlations between DC and HRV indexes (P < 0.05). After 24 months of follow-up, FBG, FINS, TG, TC and UA in the high-risk group were much higher than those in the mid risk group and the low-risk group (P < 0.05). Conclusions Juveniles with MS are basically accompanied by abnormal DC decrease, and the change is associated with the abnormality of HRV related indicators. The abnormal autonomic nervous function is more severe in the patients with DC ≤ 2.5 ms.