患儿血管迷走性晕厥直立倾斜试验血浆C型钠尿肽变化及其意义

Changes of plasma C-type natriuretic peptide during head-up tilt test in children with vasovagal syncope and its significance

目的探讨血管迷走性晕厥(vasovagal syncope,VVS)患儿血浆C-型钠尿肽(c-type natriuretic peptide,CNP)含量的变化。方法研究对象包括31例VVS患儿,均为2013年12月至2014年6月在北京大学第一医院儿科以直立不耐受症状入院的患儿,均经过详细病史询问、体格检查及相关实验室检查以及直立倾斜试验(HUTT)确诊为VVS,平均年龄为(11±3)岁;32名健康儿童为对照组,均为经过详细病史及体格检查等确定为健康的儿童,平均年龄为(11±2)岁。心率、血压的监测采用无创连续血压监测仪连续监测。血浆CNP的测定采用夹心免疫发光法。结果 VVS组与对照组的性别比、年龄、身高、体重、平卧位血压及心率差异均无统计学意义(P>0.05);VVS患儿血浆中CNP含量明显高于正常儿童[(35.7±21.5)ng/L vs.(23.2±8.0)ng/L,P<0.01)];VVS患儿的晕厥频率与血浆中的CNP含量呈明显正相关(n=31,r=0.85,P<0.01)。VVS组平卧状态下及HUTT中阳性反应时的血浆CNP含量差异无统计学意义[(36.3±21.0)ng/L vs.(42±57)ng/L,P>0.05]。结论 VVS患儿血浆CNP含量高于对照组,且血浆CNP含量与患儿晕厥频率相关,可能参与了VVS的发病过程。

Objective To explore the changes of plasma C-type natriuretic peptide （CNP） in children with VVS. Methods Thirty-one children （male 16, female 15） with VVS were included in the study, and all of them were diagnosed by detailed history taking, physical examination and related laboratory inspections as well as head-up tilt test. The mean age was （11±3） years. Another 32 healthy children （male 17, female 15） were taken as a control group, who were confirmed as healthy by detailed history, physical examination, and standing test, etc. Their mean age was （11 ±2） years. Finapres Medical System （Finapres Medical System-FMS, the Netherlands） was used to continuously monitor heart rate and blood pressure during HuTr, and ECG was performed. Sandwich immunolumineseence assay was used to test plasma CNP. Results No differences were found in age, height, weight, supine systolic blood pressure, diastolic blood pressure and mean arterial pressure between VVS group and control group （P 〉 0.05）. The plasma CNP level in VVS group was higher than that of control group in supine position [ （35.7±21.5）ng/L vs. （23.2±8） ng/L, P 〈 0.01 ]. The plasma CNP was positively correlated with syncope frequency in VVS group （r = 0.85, P 〈 0.05）. However, no significant differences were found in plasma CNP between supine position and positive response in HUTT in VVS group [ （36.3±21） ng/L vs. （42±57） ng/L, P 〉 0.05 ]. Conclusion The plasma CNP level in VVS group is higher than that of control group in supine position. The plasma CNP is positively correlated with syncope frequency in VVS group, which might play a role in the pathogenesis of VVS in children.