目的 分析体重指数(BMI)在体位性心动过速综合征(POTS)患儿和血管迷走性晕厥(VVS)患儿中的分布差异,并探讨其在上述两种疾病鉴别中的应用价值。方法 选取2015年6月至2019年12月在儿科门诊纳入以“不明原因晕厥”就诊的患儿260例,依据直立倾斜试验结果对患儿分组(POTS组110例,VVS组150例),并将同期行健康体检的82例儿童青少年作为对照组。所有受试者接受统一的身高及体重测量。计算BMI,对比分析各组间BMI分布差异,并采用受试者工作特征(ROC)曲线预测用BMI鉴别POTS和VVS患儿的诊断价值。 结果 对照组、POTS组和VVS组BMI均值分别为(20.51±2.91)kg/m2、(18.17±3.12)kg/m2和(19.91±3.69)kg/m2,其中POTS组患儿BMI较对照组和VVS组均显著降低(P＜0.001),但VVS组患儿BMI分布和对照组相比差异无统计学意义(P＝0.195)。三种VVS亚型间BMI分布差异亦有统计学意义(F＝3.229,P＝0.042)。利用ROC曲线分析BMI鉴别POTS患儿和VVS患儿的价值,结果显示ROC曲线下面积为0.644(95%CI:0.577~0.711,P＜0.001),当BMI＞19.30 kg/m2时,其预测某晕厥患儿是VVS的灵敏度和特异度分别为56.0%和71.8%。 结论 POTS患儿较VVS患儿BMI明显降低,BMI在二者的鉴别诊断中具有一定的应用价值,可结合病史、体格检查和其他辅助检查作为临床初步诊断依据。
Abstract
Objective To analyze the statistical distribution of body mass index (BMI) in children with postural tachycardia syndrome (POTS) and children with vasovagal syncope (VVS), and to explore the application value of BMI in distinguishing the two diseases. Methods A total of 260 children and adolescents who complained of unexplained syncope were enrolled in this study from June 2015 to December 2019, and were divided into POTS group (n=110) and VVS group (n=150) after definite diagnosis by HUTT. Meanwhile, 82 subjects who took physical examination were selected as the control group. The data of BMI was collected after measuring the height and weight of all subjects in the same room, and its statistical difference among the three groups above was described. Then the receiver operating characteristic (ROC) curve was used to evaluate the value of BMI in distinguishing POTS and VVS. Results The average BMI of children in control group, POTS group and VVS group were (20. 51±2. 91) kg/m2, (18. 17±3. 12)kg/m2 and (19. 91±3. 69)kg/m2, respectively. The BMI of children in POTS group was significantly lower than that in control group and VVS group (P＜0. 001). However, there was no statistically significant difference between VVS group and control group (P＝0. 195). As for the BMI difference among the three VVS subtypes, the statistically difference was significant(F＝3. 229,P＝0. 042). The area under the ROC curve of BMI was 0. 644 (95%CI: 0. 577-0. 711, P＜0. 001). Taking 19. 30 kg/m2 as threshold BMI for VVS children and adolescents, the predicted sensitivity and specificity were 56. 0% and 71. 8%, respectively. Conclusions Children and adolescents with POTS have the significantly lower BMI than those with VVS. Thus, BMI is an acceptable auxiliary method to discriminate POTS and VVS combined with medical history, physical examination and other auxiliary examinations.
关键词
体位性心动过速综合征 /
血管迷走性晕厥 /
体重指数 /
儿童青少年
Key words
postural tachycardia syndrome /
vasovagal syncope /
body mass index /
children and adolescents
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参考文献
[1] Stewart JM,Boris JR,Chelimsky G,et al.Pediatric Disorders of Orthostatic Intolerance[J].Pediatrics,2018,141(1):e20171673.
[2] 田宏.基于生物标记分子的儿童血管迷走性晕厥与体位性心动过速综合征临床鉴别诊断[J].中国实用儿科杂志,2016,31(8):572-574.
[3] 赵娟,杜军保,金红芳.儿童体位性心动过速综合征的发病机制[J].实用儿科临床杂志,2012,27(7):540-542.
[4] Arnold AC,Ng J,Raj SR.Postural tachycardia syndrome–diagnosis,physiology,and prognosis[J].Auton Neurosci,2018,215:3-11.
[5] 梁敏,刘晓燕.儿童血管迷走神经性晕厥的发病机制及治疗[J].儿科药学杂志,2017,23(6):59-62.
[6] Tiago LLL,Barcellos SR,Moraes MA,et al.Low body mass index is associated with a positive response during a head-up tilt test[J].Pacing Clin Electrophysiol,2013,36(1):37-41.
[7] 王硕,谭传梅,秧茂盛,等.儿童青少年体位性心动过速综合征体质量指数变化[J].中国实用儿科杂志,2019,34(8):685-688.
[8] 中华医学会儿科学分会心血管学组,《中华儿科杂志》编辑委员会,北京医学会儿科学分会心血管学组,等.儿童晕厥诊断指南(2016年修订版)[J].中华儿科杂志,2016,54(4):246-250.
[9] 尚丽丽,彭宇阁,刘佳,李晓红,李艳.直立倾斜试验在儿童不明原因晕厥诊断中的应用[J].中国实用神经疾病杂志,2019,22(18):2026-2031.
[10] 中华人民共和国卫生部,中国国家标准化管理委员会.学生健康检查技术规范(GB/T 26343-2010)[S].北京:中国标准出版社出版,2011.
[11] 中华人民共和国国家卫生和计划生育委员会.学龄儿童青少年营养不良筛查(WS/T 456-2014)[S].2014.
[12] 中华人民共和国国家卫生和计划生育委员会.学龄儿童青少年超重与肥胖筛查(WS/T 586-2018)[S].2018.
[13] Li H,Wang Y,Liu P,et al.Body mass index(BMI)is associated with the therapeutic response to oral rehydration solution in children with postural tachycardia syndrome[J].Pediatr Cardiol,2016,37(7):1-6.
[14] 李章勇,刘晓燕.儿童体位性心动过速综合征发病机制及治疗[J].儿科药学杂志,2016,22(10):60-63.
[15] Mar PL,Raj SR.Postural orthostatic tachycardia syndrome:mechanisms and new therapies[J].Annu Rev Med,2020,71:235-248.
[16] 黎瑶,何爽,张蕾,等.自主神经介导性晕厥儿童在直立倾斜试验中阳性反应与并发症的早期发现和处理[J].临床儿科杂志,2019(11):837-842.
[17] Joo BE,Koo DL,et al.Seizure-like activities in patients with head-up tilt test-induced syncope[J].Medicine,2018,97(51):e13602.
[18] 李佳蔚,张清友,高洁,等.血清铁在鉴别儿童血管迷走性晕厥和体位性心动过速综合征中的意义[J].北京大学学报:医学版,2013,45(6):923-927.
[19] Zhang F,Li X,Stella C,et al.Plasma hydrogen sulfide in differential diagnosis between vasovagal syncope and postural orthostatic tachycardia syndrome in children[J].J Pediatr,2012,160(2):227-231.
[20] Tao C,Chen S,Li H,et al.Value of immediate heart rate alteration from supine to upright in differential diagnosis between vasovagal syncope and postural tachycardia syndrome in children[J].Front Pediatr,2018,6:343.
[21] Montgomery LD.Regional blood volume and peripheral blood flow in postural tachycardia syndrome[J].Am J Physiol Heart Circ Physiol,2004,287(3):1319-1327.
[22] Fu Q,et al.Cardiac origins of the postural orthostatic tachycardia syndrome[J].J the Am Coll Cardiol,2010,55(25):2858-2868.
[23] Kuo AY,et al.Differential autonomic nervous system response in obese and anorexic chickens(Gallus gallus)[J].Comp Biochem Physiol B Biochem Mol Biol,2006,144(3):359-364.
基金
国家自然科学基金青年基金(81803263);浙江省卫生健康委省医药卫生科技计划项目(2020KY612)
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