硝酸甘油与异丙肾上腺素直立倾斜试验的直接对比研究

Direct comparison of nitroglycerin and isoproterenol head-up tilt testings

目的比较舌下含服硝酸甘油和静脉注射异丙肾上腺素直立倾斜试验(head-uptilttest,HUTT)诊断血管迷走性晕厥(vasovagal syncope,VVS)的价值。方法 30例无晕厥史的健康人与84例不明原因晕厥患者在1周内先后进行基础结合硝酸甘油诱发和基础结合异丙肾上腺素诱发的HUTT,比较两种方法对VVS的诊断价值及差异。结果硝酸甘油诱发的HUTT与异丙肾上腺素诱发的HUTT诊断VVS的敏感性[61.9%(52/84)vs.58.3%(49/84),P=0.750]、特异性[96.7%(29/30)vs.100%(30/30),P=0.992]、阳性预测值[98.1%(52/53)vs.100%(49/49),P=0.974]、阴性预测值[47.5%(32/61)vs.47.3%(32/61),P=0.881]比较,差异无统计学意义。两种方法一致性检验值KAPPA为0.932,但硝酸甘油诱发阳性反应时间[(8.5±3.2)minvs.(25.4±9.9)min,P<0.05]及总试验时间[(38.5±3.2)minvs.(55.4±9.9)min,P<0.05]少于异丙肾上腺素,差异有统计学意义。结论硝酸甘油激发的HUTT诊断VVS安全有效,简单易行,值得推广使用。

Objectives To directly compare the effect of nitroglycerin and isoproterenol head-up tilt testings （HUTT） for diagnosis of vasovagal syncope. Methods Thirty control subjects and 84 patients with unexplained syncope underwent HUTT with baseline plus nitroglycerin and baseline plus isoproterenol, respectively, within the same week. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV） and provoked positive time were compared for diagnosis vasovagal syncope. Results There were no significant differences between the two methods in sensitivity [ 61.9% （ 52/84 ） vs. 58.3 % （ 49/84 ）, P=0.750 ], specificity [ 96.7 % （ 29/30 ） vs. 100% （30/30）, P=0.992], PPV [98.1% （52/53） vs. 100% （49/49） ,P=0.974] and NPV [47.5% （32/61） vs. 47.3% （32/61） ,P= 0.881 ]. The two methods were with a KAPPA value （0.932）, but the provoked positive time [ （8.5±3.2） rain vs. （25.4±9.9） rain,P〈0.05] and the total time [（38.5±3.2） rain vs. （55.4±9.9） rain,P〈0.05] were much shorter in nitroglycerin HUTT than those in isoproterenol HUTT. Conclusions Sublingual nitroglycerin provoked HUTF is a safer and simpler method to diagnose VVS.