直立倾斜试验阳性结果影响因素及患者的临床特征分析

Analysis on influencing factors for positive result of head-up tilt test and vasovagal syncope patients' clinical features

目的总结影响患者直立倾斜试验(head-up tilt test,HUTT)的危险因素,并研究血管迷走性晕厥(vasovagl syncope,VVS)患者无症状期间的24 h心率变异性(heart rate variability,HRV)。方法对173例疑诊为VVS的晕厥患者进行HUTT检查,包括基础HUTT(BHUTT)和舌下含化硝酸甘油激发HUTT(SNHUTT)。根据结果分为HUTT阳性组和HUTT阴性组,分析二者的临床特征及HRV,并进行Logistic分析。结果在173例患者中,HUTT阳性组82例,HUTT阴性组91例。(1)HUTT血流动力学类型:82例HUTT阳性患者中,8例为BHUTT(血管抑制型6例,混合型2例),74例为SNHUTT(其中血管抑制型55例,心脏抑制型3例,混合型16例)。(2)临床表现:HUTT阳性组晕厥时常见伴随症状依次为胸闷或胸痛(51.22%)、头晕或头痛(50.00%)、心悸或心慌(47.56%)、大汗或出汗(39.02%)、乏力(37.80%)。(3)单因素分析:女性(χ~2=4.242,P=0.039)、≥60岁(χ~2=5.449,P=0.020)、有恶心或呕吐临床表现(χ~2=4.759,P=0.029)、有腹痛临床表现(χ~2=5.410,P=0.020)是HUTT阳性的危险因素。(4)Logistic回归分析:年龄≥60岁为HUTT阳性的独立危险因素(OR=0.520,P=0.041)。(5)24 h HRV比较:反映时域指标的r MSSD两组间差异有统计学意义[(37.41±24.19)ms vs.(30.76±13.16)ms,P=0.024]。结论性别、年龄、有恶心或呕吐、腹痛临床表现是HUTT阳性的相关因素,VSS患者无症状期间的自主神经功能异常。

Objective To summarize the risk factors of headup tilt test（HUTT） in patients with vasovagal syncope（VSS）, and to study their 24hour heart rate variability（HRV） during asymptomatic period. Methods A total of 173 patients suspected with VVS received HUTT, including basic HUTT（BHUTT） and sublingual nitroglycerin test（SNHUTT）. They were divided into HUTT positive group（82 cases） and HUTT negative group（91 cases） according to test results. The clinical characterizations and HRV of the two groups were analyzed, and multivariate Logistic regression analysis was made. Results （ⅰ） HUTT hemodynamic types： in HUTT positive group, 8 patients were positive in BHUTT（6 cases with vasodepressor syncope and 2 with mixed response） while 74 were positive in SNHUTT（55 cases with vasodepressor syncope, 3 with cardioinhibitory syncope and 16 with mixed response）. （ⅱ） Clinical manifestations： at the attack of syncope in HUTT positive group, the common accompanying symptoms were orderly chest tightness or pains（51.22%）, dizziness or headache（50.00%）, palpitation（47.56%）, sweating（39.02%） and fatigue（37.80%）. （ⅲ） Single factor analysis demonstrated that female（χ^2=4.242,P=0.039）,≥60 years old（χ^2=5.449,P=0.020）, clinical manifestations of sicchasia or emesia（χ^2=4.759, P=0.029） and symptoms of abdominal pain（χ^2=5.410, P=0.020） were risk factors for positive HUTT. （ⅳ） Logistic regression analysis indicated that ≥60 years old（OR=0.520, P=0.041） was an independent risk factor for positive HUTT. （ⅴ） Comparison of 24hour HRV： the timedomain index of rMSSD in HUTT positive group was statistically significantly higher than that in HUTT negative group[（37.41±24.19） ms vs. （30.76 13.16） ms, P=0.024]. Conclusion Sex, age, clinical features of sicchasia or emesia and abdominal pain are related factors for positive HUTT. The autonomic verve function in VVS patients during asymptomatic period is abnormal.