Alvarado Anthony M, Ward Kendra M, Muntz Devin S, Thompson Alexis A, Rodeghier Mark, Fernhall Bo, Liem Robert I
Hematology, Oncology, & Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
J Pediatr. 2015 Feb;166(2):389-93.e1. doi: 10.1016/j.jpeds.2014.10.064. Epub 2014 Dec 2.
To examine heart rate recovery (HRR) as an indicator of autonomic nervous system dysfunction after maximal exercise testing in children and young adults with sickle cell anemia (SCA).
Recovery phase heart rate (HR) in the first 5 minutes after maximal exercise testing in 60 subjects with SCA and 30 matched controls without SCA was assessed. The difference between peak HR and HR at both 1-minute (ΔHR1min) and 2-minutes recovery was our primary outcome.
Compared with controls, subjects with SCA demonstrated significantly smaller mean ΔHR1min (23 beats per minute [bpm], 95% CI 20-26 vs 32 bpm, 95% CI 26-37, P = .006) and the difference between maximal HR and HR at 2 minutes (39 bpm, 95% CI 36-43 vs 48 bpm, 95% CI 42-53, P = .011). Subjects with SCA also showed smaller mean changes in HR from peak HR to 1 minute, from 1 minute to 2 minutes, and from 2 through 5 minutes of recovery by repeated-measures testing. In a multivariable regression model, older age was independently associated with smaller ΔHR1min in subjects with SCA. Cardiopulmonary fitness and hydroxyurea use, however, were not independent predictors of ΔHR1min.
Children with SCA demonstrate impaired HRR after maximal exercise. Reduced postexercise HRR in SCA suggests impaired parasympathetic function, which may become progressively worse with age, in this population.
在镰状细胞贫血（SCA）患儿和年轻成人中，将心率恢复（HRR）作为最大运动试验后自主神经系统功能障碍的一个指标进行研究。
评估了60例SCA患者和30例匹配的无SCA对照者在最大运动试验后最初5分钟的恢复阶段心率（HR）。主要结局是峰值HR与1分钟（ΔHR1min）和2分钟恢复时HR的差值。
与对照组相比，SCA患者的平均ΔHR1min显著更小（每分钟23次心跳 [bpm]，95% CI 20 - 26 vs 32 bpm，95% CI 26 - 37，P = .006），以及最大HR与2分钟时HR的差值也更小（39 bpm，95% CI 36 - 43 vs 48 bpm，95% CI 42 - 53，P = .011）。通过重复测量检验，SCA患者从峰值HR到1分钟、从1分钟到2分钟以及从2分钟到5分钟恢复阶段的HR平均变化也更小。在多变量回归模型中，年龄较大与SCA患者较小的ΔHR1min独立相关。然而，心肺适能和羟基脲的使用并非ΔHR1min的独立预测因素。
SCA患儿在最大运动后表现出HRR受损。SCA患者运动后HRR降低表明副交感神经功能受损，在该人群中可能会随年龄增长而逐渐恶化。
