儿童直立倾斜试验的临床分析
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摘要
目的探讨儿童直立倾斜试验(HUTT)阳性率,并且通过HUTT拟诊为自主神经介导性晕厥的晕厥患儿及拟诊为慢性直立不耐受的非晕厥患儿的疾病构成及疾病比例。方法将2007年8月至2015年12月于河北医科大学第二医院儿科心血管专业拟诊为自主神经介导性晕厥的患儿分为晕厥组,将拟诊为慢性直立不耐受的患儿列入非晕厥组,对患儿行HUTT。结果晕厥组HUTT阳性率为60.6%,非晕厥组HUTT阳性率为57.6%。晕厥组112例患儿,其中血管迷走性晕厥39例(39/112),体位性心动过速综合征35例(35/112),直立性高血压13例(13/112),直立性低血压1例(1/112),直立不耐受8例(8/112),不明原因晕厥26例(26/112);非晕厥组109例患儿,其中体位性心动过速综合征43例(43/109),血管迷走性晕厥22例(22/109),直立性高血压8例(8/109),直立性低血压4例(4/109),直立不耐受9例(9/109),诊断不明确30例(30/109)。结论 HUTT是诊断自主神经介导性晕厥及慢性直立不耐受的必要及有效方法。血管迷走性晕厥是自主神经介导性晕厥最常见疾病,慢性直立不耐受中最常见疾病为体位性心动过速综合征。
Objective To explore the positive rate of head-up tilt test(HUTT), and to explore the disease composition, disease proportion of the children who were considered as auto-nervous mediated syncope and chronic OI by HUTT. Method We divided all of the research cases who were from The Second Hospital of Hebei Medical University pediatric cardiovascular outpatient department during August 2007 to December 2015 going to hospital because of syncope, dizziness, headache, chest tightness and long outlet which were considered as autonervous mediated syncope and chronic OI patients into two groups: the syncope group and the non-syncope group. All the patients were put on HUTT. Results The HUTT positive rate of the syncope group was 60.6%, and the nonsyncope group was 57.6%. Chisquare test was used to compare the difference of the HUTT positive rate between the syncope and non-syncope group, P>0.05. There were 112 cases in the syncope group. Among them, 39 cases were diagnosed with VVS(39/112). 38 cases were diagnosed with POTS(38/112). 13 cases were diagnosed with OHT(13/112). 1 case was diagnosed with OH(1/112). 8 cases were diagnosed with OI(8/112). 26 cases were not diagnosed with clear reason(26/112); In the non-syncope group, there were 109 cases. Among them, 22 cases were diagnosed with VVS(22/109). 43 cases were diagnosed with POTS(43/109). 8 cases were diagnosed with OHT(8/109). 4 cases were diagnosed with OH(4/109). 9 cases were diagnosed with OI(9/109). 39 cases were not diagnosed 234 clearly(39/109). Conclusion HUTT is an essential and effective diagnostic method for autonervous mediated syncope and OI. Vasovagal syncope is the most common disease of auto-nervous mediated syncope, and the most common chronic orthostatic intolerance is postural tachycardia syndrome.
Objective To explore the positive rate of head-up tilt test(HUTT), and to explore the disease composition, disease proportion of the children who were considered as auto-nervous mediated syncope and chronic OI by HUTT. Method We divided all of the research cases who were from The Second Hospital of Hebei Medical University pediatric cardiovascular outpatient department during August 2007 to December 2015 going to hospital because of syncope, dizziness, headache, chest tightness and long outlet which were considered as autonervous mediated syncope and chronic OI patients into two groups: the syncope group and the non-syncope group. All the patients were put on HUTT. Results The HUTT positive rate of the syncope group was 60.6%, and the nonsyncope group was 57.6%. Chisquare test was used to compare the difference of the HUTT positive rate between the syncope and non-syncope group, P>0.05. There were 112 cases in the syncope group. Among them, 39 cases were diagnosed with VVS(39/112). 38 cases were diagnosed with POTS(38/112). 13 cases were diagnosed with OHT(13/112). 1 case was diagnosed with OH(1/112). 8 cases were diagnosed with OI(8/112). 26 cases were not diagnosed with clear reason(26/112); In the non-syncope group, there were 109 cases. Among them, 22 cases were diagnosed with VVS(22/109). 43 cases were diagnosed with POTS(43/109). 8 cases were diagnosed with OHT(8/109). 4 cases were diagnosed with OH(4/109). 9 cases were diagnosed with OI(9/109). 39 cases were not diagnosed 234 clearly(39/109). Conclusion HUTT is an essential and effective diagnostic method for autonervous mediated syncope and OI. Vasovagal syncope is the most common disease of auto-nervous mediated syncope, and the most common chronic orthostatic intolerance is postural tachycardia syndrome.
引文
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[2]Stewart JM.Common syndromes of orthostatic intolerance[J].Pediatrics,2013,131(5):968-980.
[3]Vaddadi G,Lambert E,Corcoran SJ,et al.PosturaJsyncope:mechanisms and management[J].Med J Aust,2007,187(5):299-304.
[4]The Subspecialty Group of Cardiology,the Society of Pediatrics,Chinese Medical Association,The Editorial Board,Chinese Journal of Pediatrics,The Subspecialty Group of Cardiology,the Society of Pediatries,Beijing Medical Association,etc.Guideline for diagnosis of syncope in children(updated in 2016)[J].Zhonghua Er Ke Za Zhi,2016,54(4):246-250.
[5]Lin J,Wang Y,Ochs T,et al.Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance[J].Cardiol Young,2015,25(1):76-80.
[6]Kaniwal K,Calkins H.Syncope in children and adolescents[J].Cardiol Clin,2015,33(3):397-409.
[7]Lin,J,Jin H,Du J.Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope[J].Cardiol Young,2014,24(5),792-796.
[8]Tretter JT,Kavey RE.Distinguishing cardiac syncope from vasovagal syncope in a referral population[J].J Pediatr,2013,163(6):1618-1623.
[9]Low PA,Sandroni P,Joyner M,et al.Postural tachycardia syndrome[J].J Cardiovasc Electrophysiol,2009,20(3):352-358.
[10]Jarjour IT.Postural tachycardia syndrome in children and adolescents[J].Semin Pediatr Neurol,2013,20(1):18-26.
[11]Kario K.Orthostatic hypertensiona new haemodynamic cardiovascular risk factor[J].Nat Rev Nephrol,2013,9(12):726-738.
[12]Shalem T,Gloldman M,Breitbart R,et al.Orthostatic hypotension in children with acute febrile illnessr[J].J Emerg Med,2013,44(1):23-27.
[13]Stewart JM.Orthostatic intolerance in pediatrics[J].J Pediatr,2002,140:404-414.
[14]Stewart JM,Gewitz MH,Weldon A,et al.Patterns of orthostatic intolerance:the orthostatic tachycardia syndrome and adolescent chronic fatigue[J].J Pediatr,1999,135(2 Pt 1):218-225.
[15]K?se MD,Ba??,Güven B,et al.P-wave dispersion:an indicator of cardiac autonomic dysfunction in children with neurocardiogenic syncope[J].Pediatr Cardiol,2014,35(4):596-600.
[2]Stewart JM.Common syndromes of orthostatic intolerance[J].Pediatrics,2013,131(5):968-980.
[3]Vaddadi G,Lambert E,Corcoran SJ,et al.PosturaJsyncope:mechanisms and management[J].Med J Aust,2007,187(5):299-304.
[4]The Subspecialty Group of Cardiology,the Society of Pediatrics,Chinese Medical Association,The Editorial Board,Chinese Journal of Pediatrics,The Subspecialty Group of Cardiology,the Society of Pediatries,Beijing Medical Association,etc.Guideline for diagnosis of syncope in children(updated in 2016)[J].Zhonghua Er Ke Za Zhi,2016,54(4):246-250.
[5]Lin J,Wang Y,Ochs T,et al.Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance[J].Cardiol Young,2015,25(1):76-80.
[6]Kaniwal K,Calkins H.Syncope in children and adolescents[J].Cardiol Clin,2015,33(3):397-409.
[7]Lin,J,Jin H,Du J.Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope[J].Cardiol Young,2014,24(5),792-796.
[8]Tretter JT,Kavey RE.Distinguishing cardiac syncope from vasovagal syncope in a referral population[J].J Pediatr,2013,163(6):1618-1623.
[9]Low PA,Sandroni P,Joyner M,et al.Postural tachycardia syndrome[J].J Cardiovasc Electrophysiol,2009,20(3):352-358.
[10]Jarjour IT.Postural tachycardia syndrome in children and adolescents[J].Semin Pediatr Neurol,2013,20(1):18-26.
[11]Kario K.Orthostatic hypertensiona new haemodynamic cardiovascular risk factor[J].Nat Rev Nephrol,2013,9(12):726-738.
[12]Shalem T,Gloldman M,Breitbart R,et al.Orthostatic hypotension in children with acute febrile illnessr[J].J Emerg Med,2013,44(1):23-27.
[13]Stewart JM.Orthostatic intolerance in pediatrics[J].J Pediatr,2002,140:404-414.
[14]Stewart JM,Gewitz MH,Weldon A,et al.Patterns of orthostatic intolerance:the orthostatic tachycardia syndrome and adolescent chronic fatigue[J].J Pediatr,1999,135(2 Pt 1):218-225.
[15]K?se MD,Ba??,Güven B,et al.P-wave dispersion:an indicator of cardiac autonomic dysfunction in children with neurocardiogenic syncope[J].Pediatr Cardiol,2014,35(4):596-600.
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