Method for diagnosing the cases of disturbed adolescent regulation

FIELD: medicine.

SUBSTANCE: method involves evaluating the following rhythmogram values: CV% - R-R interval variability coefficient; RMSSD ms - interinterval values; pNN50% - rapid rhythm frequency and spectrogram changes: TP ms2- total spectral power; LF ms2 - spectral power in low frequency bandwidth from 0.04 to 0.15 Hz; HF ms2 - spectral power in high frequency bandwidth from 0.15 to 0.4 Hz; VLF ms2 - spectral power in very low frequency bandwidth from 0.003 to 0.004 Hz. Rhythmogram and spectrogram values being equal to: CV -4.5±0.2; RMSSD ms - 25.6±1.6; pNN50 - 7.3±1.1; TP - 998.3±74.2; LF - 300.3±33.1; HF - 291.1±39.0; VLF - 407±43.9, high activity of sympathetic division of vegetative nervous system (sympathicotonia). Rhythmogram and spectrogram values being equal to: CV -11.4±0.5; RMSSD ms - 114.7±7.9; pNN50 - 63.3±2.1; TP - 9360±952.1; LF - 2206±249.0; HF - 5323±668.8; VLF - 1832±445.3, high activity of parasympathetic division of vegetative nervous system (vagotonia).

EFFECT: high objectivity of criteria.

2 tbl

 

The invention relates to medicine, namely to Pediatrics.

The urgency of the problem stems from the fact that puberty is a critical period of child development. Neurohumoral lability of this period determines the possibility of the development of pronounced changes from vital organs and systems that can be attributed to adolescents at risk for the development of functional and chronic pathology. In addition, vegetative disturbances cause significant discomfort in the health status of students, serve as a contraindication to select many professions, restrictions conscription of boys and miscarriage in girls.

For the diagnosis of impaired autonomic regulation in children using different methods: clinical and cardiointervalography, Holter monitoring, biochemical, and others. In recent years, for the diagnosis of diseases of the cardiovascular and nervous systems, more often in adults is heart rate variability (HRV).

Currently developing methodological, physiological and clinical research focus of HRV. Along with the assessment of sympathetic and parasympathetic divisions of the autonomic nervous system (ANS), HRV is used for understanding the activation process is different controller who's mechanisms, ensure the maintenance of cardiovascular homeostasis and adaptation to changes in the internal and external environment. VRS allows to evaluate the status of the various levels of humoral, autonomic and Central cortical regulation. Especially true above all in their Teens.

The prototype of the claimed method, the authors propose a method for the diagnosis of impaired autonomic regulation in adolescents (Kushnir S.M., Antonova L.K. detection of impaired autonomic regulation and development stages neurocirculatory dystonia in children and adolescents. Patent RU 2197174 from 27.01.2003), including an assessment of the performance of ramagrama with anti-hypertensive, hypertensive and cardiac forms of neurocirculatory dystonia with the definition of stages of development. When detecting decrease sympathetic (figure AIA) and parasympathetic activity (indicator ΔX) autonomic nervous system determine the stage of subcompensation, when the increase in sympathetic and decrease in parasympathetic activity stage of irritation or decreasing sympathetic and increased parasympathetic activity - stage depression.

This method however, according to the applicants, has some disadvantages: indices of HRV were studied in a certain contingent of the surveyed children and adolescents with hypoten is positive, hypertensive and cardiac forms of neurocirculatory dystonia; used to identify impaired autonomic regulation narrow range of indicators kardiointervalogrammy (AMO ΔX); not studied the spectral characteristics of HRV.

The applicants propose to use for the diagnosis of impaired autonomic regulation in adolescents study of HRV using vegetotester program Polyspectra" company "Neurosoft" (Russia), V.M. Mikhailov. The heart rate variability. Experience in practical application. Ivanovo, 2000). When examining adolescents were recorded from 300 to 500 cardiocycle with parallel recording of the piezosensor pneumogram to determine the contribution of vagusnye activation of respiration in simpato-parasympathetic balance. Indices of HRV, which studies have found to be most significant (CV, RMSSD, pNN50, TP, LF, HF, VLF).

According to ramagrama:

- CV, percent coefficient of variation of RR interval;

- RMSSD, MS - mediterannee differences of R-R interval;

- pNN50, percent frequency of occurrence of rapid changes of rhythm.

According to the spectrogram:

- TR, MS - total power spectrum and its three components:

- LF, MC - low frequency spectrum in the frequency range of 0.04 to 0.15 Hz;

- HF-MS - high-frequency oscillation spectrum range 0,15-0,4 Hz.

- VLF, MS is a very low frequency in the range of 0.003 to 0.04 Hz.

All authors surveyed 130 children aged 10-15 years. 70 children constituted the control group (boys 26 girls - 44).

For example, healthy adolescents of the control group we studied the dependence of HRV indices from the floor of the patient. To obtain statistically reliable data for each indicator HRV was assessed significance of the differences by the gender of the patient by two statistical criteria: parametric - t-test and nonparametric - Wilcoxon. Significant differences in HRV indices from the floor of the patient (at a significance level of p<0,05). In this regard, further research was conducted without regard to sex.

60 children aged 10 to 15 years was with impaired autonomic regulation. After the examination with the help of vegetotester adolescents depending on the indicators were divided into 2 groups: 31 children with low values of the HRV indices and 29 children with increased indices of HRV. Split the children into 2 groups was confirmed by clinical and biochemical studies. 1st group (31 children) with high activity of the sympathetic division of the ANS (sympathicotonic), 2nd group (29 children) with high activity of the parasympathetic division of the ANS (vagotonia).

Summary indices of HRV have examined the undergrowth is s presented in table 1.

Table 1.

The HRV indices in adolescents 10-15 years (M±m)
IndexHealthy n=70group 1 Sympathicotonic n=312 group Vagotonic n=29
CV %7,14±0,354,5±0,211,4±0,5
RMSSD, MS57,7±4,825,6±1,6to 114.7±7,9
pNN50, %28,9±2,77,3±1,163,3±2,1
TP, MS23520±381998,3±74,29360±952,1
LF, MS21081±113300,3±33,12206±249,0
HF, MC21730±256291,1±39,05323±668,8
VLF, MS2708±76407,0±43,91832±445,3

As can be seen from table 1, the coefficient of variation (SU) decreases in the 1st group 1.6 times and increases in the 2nd 1.6 times compared with healthy adolescents. Mediterannee differences, defined in terms of RMSSD, increased in 2 times in the 2nd group and significantly decreased in the 1st group 2.3 times compared with the control group. The frequency of p. the phenomenon of rapid changes of rhythm, characteristic of the parasympathetic, was determined by the indicator pNN50, which grew in the 2nd group 2.2 times and dropped significantly in the 1st 4 times to the data group of healthy adolescents.

Of particular interest is the total spectral power (TP) and its three components in adolescents represented groups. Total spectral power increased significantly in the 2nd group - 165,9% and was significantly reduced in the 1-St group - 71,6%.

Low frequency spectrum has increased in the 2nd group on 104,1%, while in the 1st group the rate was decreased by 72.2% compared with a group of healthy adolescents. High-frequency oscillation spectrum was growing on 207,7% in children 2-Oh group and decreased by 83.2% in adolescents 1 to the data control. The impact of very low frequencies, reflecting the metabolic and emotional impact on the overall power spectrum changed with the same regularity that the low and high frequencies, but I want to note the fact that a greater contribution of these influences in adolescents 1-Oh group that, apparently, the greater emotional dependence children in this group and the corresponding increased sympathetic activity under this influence.

Statistical treatment was carried out non-parametric methods due to the fact that the indices of HRV basically do not have normal distribution, which is presented in the tables is 2.

Table 2

Analysis of variance (univariate) nonparametric method Well - Wallis HRV indices in adolescents 10-15 years with a group of healthy children.
IndexThe value of the criterion of "Chi-squared"The probability of the null hypothesisThe level of significanceDifferent couples groups
CV %81.060.0p<0.0013D-1; 3D-2; 1-2
RMSSD, MS84.890.0p<0.0013D-1; 3D-2; 1-2
PNN50, %80.530.0p<0.0013D-1; 3D-2; 1-2
TR MS281.990.0p<0.0013D-1; 3D-2; 1-2
LF, MS275.830.0p<0.0013D-1; 3D-2; 1-2
HF, MC2At 81.650.0p<0.0013D-1; 3D-2; 1-2
VLF, MS240.310.0p<0.0013D-1; 3D-2

Univariate analysis of variance showed (table. 2) no significant difference in all groups with the control group, and groups with impaired VEGA is exploring regulation between them.

Thus, the survey results indicate changes in the variability of the heart rhythm in groups of children with impaired autonomic regulation. It was found that adolescents of the 1st group (sympathicotonic) had a significant reduction (p<0.001) in all indicators of variability and the total power of the spectrum compared to other surveyed groups: CV - 4,5±0,2%, RMSSD - 25,6±1,6 MS2, pNN50 - 7,3±1,1%, TR - 998,3±74,2 MS2, LF - 300,3±33,1 MS2, HF - 291,1±39,0 MS2, VLF - 407±43,9 MS2. Adolescents 2nd group (vagotonia) was increased (p<0.001) in all indices of HRV and power spectrum, which confirms the predominance they vagusnye effects: CV - 11,4±0,5%, RMSSD - to 114.7±7,9 MS2, pNN50 and 63.3±2,1%, TP - 9360±952,1 MS2, LF - 2206±249,0 MS2, HF - 5323±668,8 MS2, VLF - 1832±445,3 MS2.

The advantages proposed by the authors of the method for the diagnosis of impaired autonomic regulation in adolescents are:

1. Obtaining objective measures of autonomic dysfunction.

2. The availability of determination of indexes of HRV in the work of medical institutions.

3. The opportunity to objectively assess the effectiveness of therapeutic interventions.

4. The purposeful treatment-correction what's measures depending on identified impaired autonomic regulation.

5. The ability of the forecast according to the HRV indices.

6. The ability to differentiate functional and border nature of autonomic dysfunction.

7. The possibility of diagnosis and early diagnosis of the syndrome of a vegetative dystonia.

Clinical example 1 (AMB. map No. 056896). Marina K., age 15. He complained of palpitations, false angina, headaches, insomnia, irritability. In the survey excluded organic pathology of the cardiovascular system, the HRV indices: CV of 4.8%, RMSSD - 30,1 MS2, pNN50 - 8,2%, TR - 774,12 MS2, LF - 277,69; HF - 264,75; VLF - 231,68. Given the parameters of HRV indicate a violation of vegetative regulation (syndrome of a vegetative dystonia), the pronounced dominance of sympathetic activity and reduced adaptive capacity of the organism. Appropriate therapy was prescribed.

Clinical example 2 (AMB. map No. 057248). Alexander S., age 14. He complained of attacks of weakness, nausea, headaches, aching pain in the heart, expressed meteosensitivity. In the survey excluded organic pathology of the cardiovascular and nervous systems, indicators DIF: CV - 13,7%; RMSSD - 136,8 MS2; pNN50 - 64,4%; TP - 12269,46 MS2, LF - 3735,44; HF - 7443,1; VLF - 1090,93. Child diagnosed - impaired autonomic regulation (syndrome of a vegetative dystonia), clear prevalence of activity and parasympathetic division of the ANS. Appropriate therapy was prescribed.

A method for the diagnosis of impaired autonomic regulation in adolescents, including an assessment of the performance of ramagrama, wherein define indicators ramagrama: CV % - coefficient of variation of R-R interval, RMSSD, MS - mediterannee differences, pNN 50% - frequency rapid changes of rhythm, and spectrograms: TR MS2- total power spectrum, LF, MC2- power spectrum in the low frequency range of 0.04 to 0.15 Hz, HF, MC2- power spectrum in the range of high frequencies 0,15-0,4 Hz, VLF, MS2- power spectrum in the range of very low frequencies of 0.003 to 0.04 Hz and the values of the indicators ramagrama and spectrograms

CV - 4,5±0,2

RMSSD - 25,6±1,6

pNN50 - 7,3±1,1

TP - 998,3±74,2

LF - 300,3±33,1

HF - 291,1±39,0

VLF - 407±43,9

diagnose high activity of the sympathetic division of the autonomic nervous system (sympathicotonia), and a value of indicators ramagrama and spectrograms

CV - 11,4±0,5

RMSSD - to 114.7±7,9

pNN 50 - 63,3±2,1

TP - 9360±952,1

LF - 2206±249,0

HF - 5323±668,8

VLF - 1832±445,3

- high activity of the parasympathetic division of the autonomic nervous system (vagotonic).



 

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