儿童早复极综合征的心率变异性分析

目的 分析早复极综合征(ERS)患儿的心率变异性(HRV),研究儿童ERS与HRV之间的关系.方法 对郑州大学第五附属医院2006年1月至2012年6月儿科门诊及住院诊断明确的23例ERS患儿(临床观察组)予动态心电图监测及HRV分析;另对郑州市城区2所小学行心血管健康检查中选取性别、年龄匹配的30例健康儿童(健康对照组)的心电图信号各项参数进行分析、比较,了解2组参数之间的差异.结果 与健康对照组比较,临床观察组时域指标中标准差、差值的均方根、差值＞50 ms的百分比差异均有统计学意义(P均＜0.05),均值标准差差异无统计学意义(P＞0.05);频域指标中高频、低频与高频的比率差异均有统计学意义(P均＜0.05),极低频、低频差异无统计学意义(P＞0.05).结论 ERS患儿存在神经调节失衡,有迷走神经张力增高、交感神经正常的现象.     

学龄期儿童功能性ST-T改变心率变异性研究

目的探讨心率变异性（HRV）对正常学龄期儿童心电图功能性ST-T改变的临床意义。方法选择50例有功能性ST-T改变的学龄期儿童、43例伴ST-T改变的同年龄心肌炎患儿,及50例无ST-T改变的学龄期健康儿童,三组均进行12导联同步常规心电图及动态心电图检查,并分析其HRV参数。结果功能性ST-T改变儿童的HRV时域指标与健康儿童比较,心率增快,PNN50、rMSSD、SDSD降低,SDNN、SDANN升高,差异有统计学意义（P均<0.05）;伴ST-T改变的心肌炎患儿与功能性ST-T改变和对照儿童比较,心率增快,PNN50、rMSSD、SDSD降低,SDNN、SDANN也降低,差异有统计学意义（P均<0.05）。结论学龄期儿童自主神经功能尚不稳定,功能性ST-T改变与迷走神经活性降低,交感神经相对值增高,交感－迷走神经平衡状态失常相关。HRV对于功能性ST-T改变具有重要诊断意义。     

肥胖儿童心率变异性分析

目的 了解肥胖儿童心率变异性的特征。方法 用Holter对62例单纯性肥胖儿童和61例非肥胖儿童连续记录24h心电信号，进行心率变异性分析。结果 肥胖儿童心率变异性的时域指标：窦性心律RR问期标准差(SDNN)和相邻窦性心律RR问期差的均方根(rMSSD)低于非肥胖儿童；频域指标：高频功率(HF)和低频功率(LF)低于非肥胖儿童，结果有统计学意义。结论 肥胖儿童心率变异性减小，迷走神经功能降低。     

儿童扩张型心肌病心率变异性分析

目的 探讨儿童扩张型心肌病(DCM)心率变异性(HRV)特点.方法 对36例DCM儿童(DCM组)和54例健康儿童(对照组)长程心率变异指标进行分析.结果 DCM组的时域指标,包括全部正常心动周期(NN间期)的标准差(SDNN)、全程每天5分NN间期平均值的标准差(SDANN)、全程相邻NN间期之差的均方根值(rMSSD)、相邻NN间期之差＞ 50 ms的心搏数占心搏总数的百分比(PNN50)明显降低,与正常对照组比较有统计学意义(P ＜ 0.05);DCM组的频域指标,包括极低频段功率(VLF)、低频段功率(LF)、高频段功率(HF)明显下降,与正常对照组比较差异有统计学意义(P ＜ 0.05);不同心功能的DCM组及2例DCM死亡病例随着心功能的恶化,HRV各指标均呈进行性下降.结论 DCM患儿的HRV明显降低,显示其存在明显的自主神经功能受损和失衡,HRV对预测DCM患儿疾病的病情发展和预后有一定实用价值.     

学龄前儿童病毒性心肌炎心率变异性与心率减速力分析

目的探讨病毒性心肌炎患儿心率变异性(HRV)与心率减速力(DC)各项指标变化的临床意义。方法对56例病毒性心肌炎患儿与58例正常对照儿童进行24 h动态心电图检查,应用美国DMS公司的动态心电分析系统软件,对HRV及DC各项参数进行分析对比;并分析DC与其他各项指标之间的相关性。结果与正常对照儿童比较,病毒性心肌炎患儿时域分析的各项参数包括正常窦性RR间期的标准差(SDNN)、每5 min时段内平均正常窦性RR间期的标准差(SDANN)、全程RR间期差的均方根(RMSSD)及频域分析的低频功率(LF)的差异均无统计学意义(P>0.05),而高频功率(HF)显著减低,差异有统计学意义(P<0.05),且DC显著减低,差异有统计学意义(P<0.01)。相关性分析中,DC与SDNN、LF、HF均成正相关,其中与HF的相关性最强(r=0.51,P<0.01)。结论病毒性心肌炎患儿存在迷走神经功能受损,心率变异性中的HF与DC反映迷走神经功能的指标均显著降低,且两者具有很大相关性。     

学龄期肥胖儿童心脏自主神经功能分析

目的对学龄期肥胖儿童的心率减速力(DC)、心率加速力(AC)及心率变异性(HRV)进行分析,并观察肥胖儿童体重指数(BMI)与DC、AC及HRV的相关性。方法选取学龄期肥胖儿童108例,其中血脂正常组75例,血脂异常组33例,另选取103例学龄期健康儿童为对照组。对所有受试者行24 h动态心电图检查,分别将肥胖组与对照组、肥胖儿童中血脂异常组与血脂正常组的DC、AC及HRV进行比较,并将肥胖儿童的BMI与DC、AC及HRV进行相关性分析。结果肥胖组的DC、RR间期总体标准差(SDNN)、RR间期平均值的标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、低频功率(LF)、高频功率(HF)均低于对照组,AC高于对照组(P0.05)。肥胖儿童中血脂异常组的DC、SDNN、SDANN、RMSSD、LF、HF均低于血脂正常组,AC、BMI高于血脂正常组(P0.01)。肥胖儿童BMI与DC、SDNN、SDANN、RMSSD、HF呈明显负相关(P0.05);与AC呈明显正相关(P0.05)。结论学龄期肥胖儿童的自主神经功能受损,表现为迷走神经张力减低,其中合并血脂异常者以上表现尤为突出。肥胖程度越高,迷走神经张力越低,发生心血管疾病的危险性可能越大。     

血管迷走性晕厥儿童心率变异性分析

目的探讨血管迷走性晕厥(VVS)儿童的心率变异性(HRV)。方法对27例不明原因晕厥患儿经直立倾斜试验(HUTT)检查阳性并诊断为VVS的HRV进行分析(研究组),并将29例健康儿童作为对照(对照组)。采用康泰TLC3000A12通道动态心电图分析系统描记未发生晕厥时24h心电图,分析时域指标和频域指标,应用SPSS11.0软件进行统计学处理。结果研究组低频功率(LF)与对照组比较明显降低(P<0.05);频域指标与时域指标在不同年龄段差别不明显(P>0.05);女性时域指标中SDANN及VLF、LF较男性明显降低(P<0.05);血管抑制型与混合型VVS的HRV指标差异不明显。结论VVS儿童基础自主神经功能发生改变;HRV主要受性别影响,而年龄影响不明显;HUTT不同反应类型VVS的HRV不存在差别。     

心率变异性分析有助于对儿童不明原因心悸的诊断

目的：心率变异性作为评价患儿心率变异程度的量化指标,临床上应用越来越广泛。该研究的目的是探讨不明原因心悸患儿心率变异性(HRV)的特点,为心悸患儿的临床诊断提供参考。方法：对34例不明原因心悸患儿,27例正常儿童进行动态心电图检查,分析动态心电图的STT变化及心率的昼夜节律变化,心率变异性时域指标两两比较。结果：心悸患儿时域指标相邻正常RR间期均数的标准差(SDNN)、相邻正常RR间期差值的均方根(RMSSD)、相邻正常RR间期差值大于50ms的个数占总心博数的百分比(PNN50)降低,与对照组相比差异有显著性(P<0.05)。其中15例患儿STT改变的特点符合β受体功能亢进症的诊断标准。结论：不明原因心悸患儿的心率变异性时域指标SDNN,RMSSD,PNN50均有下降,结合STT改变的特点,心率变异性分析可为临床诊断β受体功能亢进症和心脏神经官能症提供参考。     

正常儿童动态心电图窦性心率及心率变异分析

目的探讨正常儿童心率及心率变异性(HRV)特点。方法对804例正常儿童进行24h全程动态心电图检查,分析心率及HRV。结果不同年龄儿童窦性心率范围不同,年龄越小心率越快;儿童不同性别间HRV中24h内全部正常心动周期的标准差(SDNN)、24h内每5minNN间期标准差的平均值(SDNNindex)、NN50占所有N-N间期个数的百分数(PNN50)、极低频率(VLF)、低频(LF)差异有显著性;儿童不同年龄组间24h内5min节段平均心动周期的标准差(SDANN)、VLF、LF、全程相邻NN间期之间的均方根值(rMSSD)差异有显著性;儿童组与成人正常参考值中SDNN、SDANN、rMSSD差异有显著性,rMSSD儿童组中明显高于成人组。结论HRV是一种反映自主神经活性及其平衡的能定量、可重复的非侵入性的检测方法,是自主神经系统与心血管系统相互制约的结果。不同年龄、不同性别间儿童HRV存在显著差异;儿童组与成人参考值存在显著差异,尤其rMSSD儿童明显高于成人,提示儿童的自主神经功能较成人活跃,而随着年龄增长自主神经功能减退,尤其是迷走神经的紧张抑制功能明显减退。     

心脏神经症患儿心率变异性分析

目的通过对心率变异性的分析,了解心脏神经症患儿的自主神经功能情况。方法回顾性分析2011年8月至2013年2月以“胸闷、叹息样长叹气”为主诉,于中国医科大学附属盛京医院小儿心血管内科病房住院诊治,但各项检查均正常,未发现器质性改变的心脏神经症患儿22例（试验组）,以及发育儿科门诊健康体检儿童20例（对照组）的心率变异性指标。结果除外年龄、性别干扰因素影响,试验组患儿心率变异性指标SDNN、SDANN、rMSSD、PNN50、TF、LF、HF较对照组明显下降,两组比较差异有统计学意义（P〈0．05）。结论心脏神经症患儿的自主神经功能紊乱,迷走神经活性明显降低。     

Analysis of an automated background correction method for cardiovascular MR phase contrast imaging in children and young adults

Background

Phase contrast magnetic resonance imaging (MRI) is a powerful tool for evaluating vessel blood flow. Inherent errors in acquisition, such as phase offset, eddy currents and gradient field effects, can cause significant inaccuracies in flow parameters. These errors can be rectified with the use of background correction software.

Objective

To evaluate the performance of an automated phase contrast MRI background phase correction method in children and young adults undergoing cardiac MR imaging.

Materials and methods

We conducted a retrospective review of patients undergoing routine clinical cardiac MRI including phase contrast MRI for flow quantification in the aorta (Ao) and main pulmonary artery (MPA). When phase contrast MRI of the right and left pulmonary arteries was also performed, these data were included. We excluded patients with known shunts and metallic implants causing visible MRI artifact and those with more than mild to moderate aortic or pulmonary stenosis. Phase contrast MRI of the Ao, mid MPA, proximal right pulmonary artery (RPA) and left pulmonary artery (LPA) using 2-D gradient echo Fast Low Angle SHot (FLASH) imaging was acquired during normal respiration with retrospective cardiac gating. Standard phase image reconstruction and the automatic spatially dependent background-phase-corrected reconstruction were performed on each phase contrast MRI dataset. Non-background-corrected and background-phase-corrected net flow, forward flow, regurgitant volume, regurgitant fraction, and vessel cardiac output were recorded for each vessel. We compared standard non-background-corrected and background-phase-corrected mean flow values for the Ao and MPA. The ratio of pulmonary to systemic blood flow (Qp:Qs) was calculated for the standard non-background and background-phase-corrected data and these values were compared to each other and for proximity to 1. In a subset of patients who also underwent phase contrast MRI of the MPA, RPA, and LPA a comparison was made between standard non-background-corrected and background-phase-corrected mean combined flow in the branch pulmonary arteries and MPA flow. All comparisons were performed using the Wilcoxon sign rank test (α?=?0.05).

Results

Eighty-five children and young adults (mean age 14 years; range 10 days to 32 years) met the criteria for inclusion. Background-phase-corrected mean flow values for the Ao and MPA were significantly lower than those for non-background-corrected standard Ao (P?=?0.0004) and MPA flow values (P?<?0.0001), respectively. However, no significant difference was seen between the standard non-background (P?=?0.295) or background-phase-corrected (P?=?0.0653) mean Ao and MPA flow values. Neither the mean standard non-background-corrected (P?=?0.408) nor the background-phase-corrected (P?=?0.0684) Qp:Qs was significantly different from 1. However in the 27 patients with standard non-background-corrected data, the difference between the Ao and MPA flow values was greater than 10%. There were 19 patients with background-phase-corrected data in which the difference between the Ao and MPA flow values was greater than 10%. In the subset of 43 patients who underwent MPA and branch pulmonary artery phase contrast MRI, the sum of the standard non-background-corrected mean RPA and LPA flow values was significantly different from the standard non-background-corrected mean MPA flow (P?=?0.0337). The sum of the background-phase-corrected mean RPA and LPA flow values was not significantly different from the background-phase-corrected mean MPA flow value (P?=?0.1328), suggesting improvement in pulmonary artery flow calculations using background-phase-correction.

Conclusion

Our data suggest that background phase correction of phase contrast MRI data does not significantly change Qp:Qs quantification, and there are residual errors in expected Qp:Qs quantification despite background phase correction. However the use of background phase correction does improve quantification of MPA flow relative to combined RPA and LPA flow. Further work is needed to validate these findings in other patient populations, using other MRI units, and across vendors.     

Observations on the use of three different contrast sensitivity tests in children and young adults

Forty-one children and young adults aged 4 to 25 years (mean 14.5 +/- 6.9, SD) with normal eyes were examined with three different contrast sensitivity tests: the Vistech distance and near test, the Cambridge Low Contrast Gratings test, and the LH-5 Contrast test. In different age groups, the youngest children aged 4 to 9 years had the lowest result values. The results of the older children aged 10 to 15 years and young adults aged 16 to 25 years were close to each other. The range of the results in all tests was large in every age group. The values of contrast sensitivity could not be compared from one test to another; in the Vistech tests the values varied from 10 to 200, in the Cambridge test from 170 to 560, and in the LH-5 test from 5 to 50. Most of the children liked the LH-5 test best, while most of the young adults preferred the Vistech distance test. It is useful to examine children and adults with different contrast sensitivity tests; however, the same test should be used in follow-up examinations.     

Respiratory motion in children and young adults undergoing liver magnetic resonance imaging with intravenous gadoxetate disodium contrast material

Background

Gadoxetate disodium, utilized in hepatobiliary magnetic resonance (MR) imaging, has been associated with transient respiratory motion during the arterial phase in adults.

Objective

The purpose of this study was to determine the presence and severity of this phenomenon in children imaged awake versus under general anesthesia.

Materials and methods

This retrospective cohort study was approved by the institutional review board; informed consent was waived. One hundred thirty exams of children ≤18 years old who underwent dynamic liver MR imaging with gadoxetate disodium between October 2010 and January 2018 were reviewed. Three pediatric radiologists scored respiratory motion artifacts on all imaging phases using a 5-point Likert scale. Differences in mean motion scores were assessed with analysis of variance and Tukey’s multiple comparisons test, and multivariable regression was used to identify predictors of arterial phase motion in awake patients.

Results

One hundred thirty patients (50% [n=65] female; mean age: 9.8±3.7 years, 48.5% [n=63] awake) were included. There were significant differences in mean motion scores between phases in the awake cohort (P<0.0001) but not in the general anesthesia cohort (P=0.051). In the awake cohort, arterial phase motion score (mean: 3.52±0.83) was significantly higher than mean motion score in all other phases (P≤0.0003). There were no significant patient-specific predictors of arterial phase motion score in the awake cohort.

Conclusion

Significantly increased arterial phase respiratory motion artifact in awake children undergoing dynamic liver MR imaging with gadoxetate disodium suggests that transient respiratory motion occurs in children. General anesthesia may suppress this phenomenon.

     

Outcome of children with school refusal

Objective To assess prospectively the psychiatric diagnostic status, psychosocial correlates, and short-term outcome of youngsters with school refusal. Methods Thirty-three subjects (8–16 years) presenting with school refusal to a tertiary Child and Adolescent Psychiatry service were evaluated. Instruments administered at baseline and after 3 months (including an outcome measure at 3 months) were: The Missouri Assessment of Genetics Interview for Children (MAGIC) to ascertain psychiatric diagnoses, a modified version of Parent Interview Schedule (PIS), and the Children’s Global Assessment Scale (CGAS). Results Twenty-nine subjects (87.9%) had a psychiatric diagnosis at baseline. Depressive disorder (63.6%) was commonest followed by specific phobias (30.3%). Psycho-social factors influenced school refusal in a majority (87.9%). Twenty of the thirty subjects (66.6%) who could be followed-up had returned to school. Psychiatric diagnosis persisted in 16 subjects. Younger age, being last-born, no or one diagnosis, and good baseline functioning predicted a favorable outcome. Conclusions Psychiatric morbidity is high in a clinic population of youngsters with school refusal. It is associated with temperamental, family, and other environmental adversities. Short-term outcome in these children is largely favourable in terms of return to school and global functioning.     

Auditory dysfunction in children with school problems

One hundred thirty-three children with school problems referred to a hospital-based multi-disciplinary clinic were screened audiologically to determine the frequency of auditory problems, and to determine whether one could predict auditory problems from clinical data. Ninety-three (69.9%) failed one or more parts of the screening procedure. Twenty-two children (7.9% of the total group) had abnormal hearing acuity, 33 (30.6%) abnormal speech discrimination in noise, and 73 (62.4%) abnormal short term auditory memory. These figures are significantly higher than those found in a representative sample of school children. Not one of 16 items from parent and teacher questionnaires and neurodevelopmental findings predicted auditory acuity or speech in noise problems; there were correlations between short term auditory memory items and parental and teacher rating of a language problem, teacher rating of reading and sequencing problem, and neurodevelopmental finding of auditory sequencing problem. In view of this inability to clinically predict auditory processing deficits, the authors suggest that a full audiological assessment, including short term memory and speech in noise testing, is warranted as part of the evaluation of children with learning difficulties.     

经药物治疗的癫痫在学儿童的学习前景:500例调查分析

目的 了解治疗中的在学癫痫儿童之学习状况和升学概况。方法 随机收集规则治疗并随访的癫痫在学儿童资料(1980～1995年)500名,所有患儿均接受抗癫痫药物治疗3年以上,并随访其发作情况及学习情况。包括小学阶段500名及其后升入初中阶段100名的学习情况;此外另调查100名儿童初中毕业后去向。结果 最终能完成小学阶段学习的癫痫儿童共477名(95.4％);癫痫组与健康组儿童小学成绩因前者留级人次较多而有显著差异(P<0.05);100名初中毕业儿童中有62人升人高中。在学癫痫儿童经治疗一年内能控制发作者占68％,其中部分儿童学习良好。结论 上述研究结果对癫痫儿童及与之相关的社会人群鼓舞很大。对这一慢性、发作性疾病儿童的疾病控制、学习问题和心理特征方面需予特殊关注,以有效改善学习状况,利于今后的择业和生活质量。     

Acute trichinellosis in children compared with adults

OBJECTIVES: Trichinellosis is a cosmopolitan parasite infection caused by Trichinella nematodes that is acquired from consumption of raw meat from several animal species. Knowledge of the clinical pattern and laboratory features of the disease in childhood is limited. The purpose is to study the clinical pattern of trichinellosis caused by Trichinella britovi in children and to compare it in household adults. METHODS: We evaluated all children up to 17 years of age and their adult householders exposed to the consumption of infected meat during an outbreak of trichinellosis. A questionnaire was developed to record clinical data. The blood sample was collected for blood count, muscle enzymes, serum electrolytes, albumin and serology. All exposed children were treated with mebendazole, and severe symptomatic patients received prednisolone. Clinical and laboratory presentations and outcome were recorded. To evaluate the clinical picture of trichinellosis in childhood, clinical and laboratory findings were compared between children and household adults with a confirmed diagnosis who consumed the same amount of infected meat. RESULTS: In 47 (62%) of 76 children with suspected trichinellosis, the diagnosis was serologically confirmed. The main clinical and laboratory findings in children were fever, abdominal pain, myalgia, facial and/or eyelid edema, rash, eosinophilia and increased muscular enzymes. The incubation period was similar in children and adults, but myalgia (66% versus 96%, P < 0.01), facial and/or eyelid edema (57% versus 86%, P < 0.05), eosinophilia (52% versus 96%, P < 0.01) and increased serum creatine kinase (38% versus 79%, P < 0.01) were less common in children than in adults. Seroconversion occurred in fewer children than adults, but the difference was not statistically significant. CONCLUSIONS: T. britovi infection shows a benign course and a milder clinical picture in children than in adults who consumed the same amount of infected meat.