摘要
目的探讨小儿血管迷走性晕厥的临床特征和血浆、血小板中5-羟色胺（5-HT）的变化。方法2006年10月-2009年2月在首都儿科研究所经直立倾斜试验（head—uptihtest，HUTT）确诊为血管迷走性晕厥（VVS）患儿41例（HUTT阳性组），诊断标准参照基础HUTT对儿童不明原因晕厥的诊断研究，男17名，女24名，年龄6—14岁，平均年龄（10．5±1．8）岁。匹配健康儿童（对照组）：当地幼儿园和中小学36名健康小儿，男16名，女20名，年龄9～14岁，平均年龄（10．7±1．5）岁。分析晕厥诱因和先兆症状、HUTT反应方式、晕厥发作时间、VVS患儿静息状态各亚型血压和心率变化等临床特点。全体研究对象抽取静脉血3ml，用双抗体夹心酶标免疫分析（ELISA）法对41例血管迷走性晕厥患儿及36名健康儿童的血浆和血小板中5-HT进行测定。结果①41例血管迷走性患儿平均年龄为（10．5±1．8）岁，女童比例高于男童，为1．4：1。②VVS先兆症状：患儿中33例存在晕厥先兆（80．4％），其中头晕发生率高达78．8％。③VVS发生诱因：儿童VVS发作前常存在诱发因素，包括：长久站立、劳累、情绪影响等。其中长久站立比例最高，达90．2％。④HUTT平均反应时间及晕厥持续时间：基础直立倾斜试验（BHUT）阶段平均反应时间为（20．64-8．6）min；舌下含化硝酸甘油激发倾斜试验（SNHUT）阶段平均反应时间（5．0±2．2）min。晕厥持续时间均短于5min。⑤HUTT不同反应类型的分布：血管抑制型61．0％，混合型24．4％，心脏抑制型14．6％。⑥血压和心率的比较：VVS患儿和正常儿童静息状态下基础心率、收缩压、舒张压相比差异无统计学意义；VVS患儿中血管抑制型、混合型和心脏抑制型静息状态下基础心率、收缩压、舒张压相比差异无统计学意义。⑦VVS患儿基础状态和HUTT阳性时血浆中5-HT较对照组差�
Objective To investigate clinical features of childhood vasovagal syncope （VVS） and the possible relationship between changes of plasma and platelet 5-hydroxytryptamine （5-HT） and childhood VVS. Method Forty-one children who were diagnosed as VVS because of positive head-up tilt test （HUTT） in Capital Institute of Pediatrics were enrolled as HUT-positive group, while 36 healthy children as control group. Clinical features of all children were analyzed, and blood samples of all children were obtained. Plasma and platelet 5-HT was measured by enzyme-linked immunosorbent assay （ELISA）. Result （ 1 ） The mean age of 41 VVS children was （ 10. 5 ± 1.8） years, and there were more girls than boys with the boys to girls ratio of 1： 1.4. （2） Presyncopal symptoms occurred in 33 patients （80.4%）, among whom dizziness had a high rate： 78.8%. （3） Commonly, there were some provocation factors before syncope, among which long-time standing was the most common one with the rate of 91.7%. （4） The mean time of positive response in BHUT and SNHUT were （ 20. 6 ± 8. 6 ） minutes and （ 5. 0 ± 2. 2 ） minutes, respectively. Duration of syncope was shorter than 5 minutes. （5） HUTT positive response included vasodepressor type with the rate of 61.0%, cardioinhibitory type with 14. 6%, and mixed type with 24. 4%. （6） There were no significant differences in baseline heart rate, systolic blood pressure and diastolic blood pressure between VVS children and healthy children. And it was the same among different types of VVS children. （7） There were no significant differences in plasma 5-HT between VVS group of baseline or HUTT-positive and control group [ （27. 51 ± 1.32） μg/L vs. （27. 28 ±2. 48） μg/L, t =0. 518, P =0. 606; （27. 51 ± 1.32） μg/L vs. （28. 05 ± 1.40 ） μg/L, t = 2. 044, P = 0. 167 ] . There were no significant differences in platelet 5-HT concentration between VVS group of baseline and control group [ （ 82. 30 ± 6. 06 ） 109 ng/L vs. （ 79
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2010年第1期39-43,共5页
Chinese Journal of Pediatrics
基金
首都医学发展科研基金资助项目（2007-3084）
