Azab Seham F A, Siam Ahmed G, Saleh Safaa H, Elshafei Mona M, Elsaeed Wafaa F, Arafa Mohamed A, Bendary Eman A, Farag Elsayed M, Basset Maha A A, Ismail Sanaa M, Elazouni Osama M A
From the Faculty of Medicine, Zagazig University, Zagazig City, Egypt (SFAA, AGS, SHS, MME, WFE, MAA, EAB, EMF, MAAB, SMI, OMAE).
Medicine (Baltimore). 2015 Jul;94(28):e1150. doi: 10.1097/MD.0000000000001150.
The mechanism of breath-holding spells (BHS) is not fully understood and most probably multifactorial; so, this study was designed to clarify the pathophysiology of BHS through assessing some laboratory parameters and electrocardiographic (ECG) changes which might be contributing to the occurrence of the attacks. Another aim of the study was to evaluate the differences in the pathophysiology between pallid and cyanotic types of BHS. This was a prospective study performed in Zagazig University Hospitals. Seventy-six children diagnosed with BHS were included as follows: 32 children with cyanotic BHS, 14 children with pallid BHS, and 30 healthy children as a control group. All children were subjected to the following: full history taking, clinical examination, and laboratory work up in the form of CBC, serum iron, ferritin, and zinc levels. Twenty-four hours ambulatory ECG (Holter) recording was also performed. No significant statistical difference was found between cyanotic and pallid groups regarding family history of BHS, severity, and precipitating factors of the attacks. Frequent runs of respiratory sinus arrhythmia (RSA) during 24 hours ECG were significantly higher in children with BHS; the frequency of RSA was significantly correlated with the frequency (severity) of the attacks. Low serum ferritin was significantly associated with BHS groups but not correlated with the severity of the attacks. Autonomic dysregulation evidenced by frequent RSA is considered to be an important cause of BHS in children and is correlated with the frequency of the attacks. Low serum ferritin is additional factor in the pathophysiology. Both pallid and cyanotic BHS are suggested to be types of the same disease sharing the same pathophysiology.
屏气发作（BHS）的机制尚未完全明确，很可能是多因素的；因此，本研究旨在通过评估一些实验室参数和心电图（ECG）变化来阐明BHS的病理生理学，这些参数和变化可能与发作的发生有关。本研究的另一个目的是评估苍白型和青紫型BHS在病理生理学上的差异。这是一项在扎加齐格大学医院进行的前瞻性研究。76名被诊断为BHS的儿童被纳入研究，具体如下：32名青紫型BHS儿童，14名苍白型BHS儿童，以及30名健康儿童作为对照组。所有儿童均接受了以下检查：详细的病史采集、临床检查，以及以全血细胞计数、血清铁、铁蛋白和锌水平形式进行的实验室检查。还进行了24小时动态心电图（Holter）记录。在BHS的家族史、发作的严重程度和诱发因素方面，青紫型和苍白型组之间未发现显著的统计学差异。在24小时心电图检查期间，BHS儿童出现频繁的呼吸性窦性心律失常（RSA）的情况明显更多；RSA的频率与发作的频率（严重程度）显著相关。低血清铁蛋白与BHS组显著相关，但与发作的严重程度无关。频繁的RSA所证明的自主神经调节异常被认为是儿童BHS的一个重要原因，并且与发作的频率相关。低血清铁蛋白是病理生理学中的另一个因素。苍白型和青紫型BHS都被认为是同一种疾病的不同类型，具有相同的病理生理学。
