年龄和性别对直立倾斜试验诊断血管迷走性晕厥结果的影响

Effect of Age and Gender on Head-up Tilt Test for Diagnosing the Patients With Suspected Vasovagal Syncope

目的：探讨年龄和性别对疑似血管迷走性晕厥（VVS）患者进行直立倾斜试验（HUTT）诊断结果的影响。方法：收集2008-08至2012-12在阜外心血管病医院进行HUTT检查的患者共1 223例,其中男性549例。患者年龄7-79岁,按年龄依次分为≤20岁组、21-40岁组、41-60岁组和〉60岁组。HUTT包括30 min的基础试验阶段和（或）20 min的药物（硝酸甘油）试验阶段。根据阳性患者血压和心电学的变化,VVS分为血管抑制型、心脏抑制型和混合型。结果：HUTT阳性率为51%（624/1 223例）,女性阳性率高于男性（60.1%vs 39.9%,P=0.001）。四组阳性率依次为68.3%、49.1%、48.6%和47.9%。阳性患者中混合型占51.4%（321例）,血管抑制型占28.7%（179例）,心脏抑制型占19.9%（124例）。HUTT阳性类型的分布受年龄因素的影响（男性：χ2=15.65,P=0.016;女性：χ2=18.84,P=0.004）,性别间差异无统计学意义（P〉0.05）。基础试验阶段74.8%的阳性反应出现在试验开始后22.5（17.5-27.5）min,但无年龄性别差异（P〉0.05）;药物试验阶段81.9%的阳性反应出现在试验开始后7.5（5-10）min,女性发生阳性反应的时间比男性提前（7.5 min vs 10 min,P=0.004）,无年龄差异。结论：HUTT诊断VVS的阳性率、阳性分型和发生阳性反应的时间存在年龄和性别差异。

Objective： To explore the effect of age and gender on head-up tilt test （HUTT） for diagnosing the patients with suspected vasovagal syncope （VVS）. Methods： A total of 1223 patients who received HUTT in our hospital from 2008-08 to 2012-12 were studied. The patients were from 7 to 79 years of age and divided into 4 groups. Group 1, the patients≤20 years of age, n=145, Group 2, the patients at （21-40） years, n=375, Group 3, the patients at （41-60） years, n=584 and Group 4, the patients〉60 years, n=119. The HUTT comprised a 30 min basic phase and 20 min sublingual nitroglycerin provocation phase. According to ECG and blood pressure changes, the HUTT positive patients included vasodepressor type, cardio-inhibitory type and mixed type. Results： The overall positive rate of HUTT was 51%（624/1223） and the female was higher than male, （60.1%vs 39.9%）, P=0.001. The positive rates in 4 age groups were at 68.3%, 49.1%, 48.6% and 47.9% respectively. In HUTT positive patients, there were 51.4% （321/624） patients with mixed type of VVS, 28.7% （179/624） with vasodepressor type of VVS and 19.9% （124/624） with cardio-inhibitory type of VVS. The positive HUTT reaction was inlfuenced by the age as in male：x2=15.65, P=0.016 and in female：x2=18.84, P=0.004. For basic phase of HUTT, there were 74.8%of positive reactions started at 22.5 （17.5-27.5） min of the test without age difference, P〉0.05;for sublingual nitroglycerin provocation phase of HUTT, there were 81.9%positive reactions started at 7.5 （5-10） min and the female was earlier than male （7.5 vs 10） min, P=0.004. Conclusion： There were age and gender differences for HUTT diagnosing the patients with VVS for their positive rate, type and starting time.