直立倾斜试验诱发晕厥与血管迷走性晕厥再发的相关性分析

Analyzing the correlation between iduced syncope in head-up tilt test and recurrence of syncope in vasovagal syncope patients

目的分析直立倾斜试验(head-up tilt test,HUTT)诱发晕厥与血管迷走性晕厥(vasovagal syncope,VVS)患者晕厥再发的相关性。方法选择2016年4月至2018年6月在宁波市第一医院HUTT试验中出现阳性反应且诊断为VVS的214例门诊或住院患者,按HUTT中有无发生晕厥分为晕厥组和无晕厥组,对两组患者HUTT时的血压、心率、异常心电现象及血管迷走神经性晕厥国际研究(VASIS)类型发生率进行比较,随访6~32个月观察患者自然状态下的晕厥再发率。结果无晕厥组患者118例,晕厥组96例。晕厥组血压值为0/0 mmHg(80.2%对66.9%,P<0.05)、异常心电现象(18.8%对8.5%,P<0.05)及VASIS分类2B型的发病率(7.3%对0.8%,P<0.05)明显高于无晕厥组。但两组间及两组VASIS阳性类型间的晕厥再发率均差异无统计学意义(组间:25.5%对24.7%,1型:13.2%对7.8%,3型:12.2%对13.0%,1型+2型:13.2%对11.7%;均P>0.05),无晕厥组2型VVS患者无晕厥再发。二元logistics回归分析显示可能的相关因素糖尿病(OR=0.530)、基础心率(OR=0.999)、发病年数(OR=1.518)、异常心电现象(OR=0.774)、VASIS 1型(OR=0.586)、VASIS 2A型(OR=0.374)、VASIS 2B型(OR=0.798)、VASIS 3型(OR=1.000)、血压值0/0 mmHg(OR=0.662)、血压下降时间(OR=1.014)均不能预测未来晕厥再发(P>0.05)。结论HUTT诱发晕厥与HUTT阳性的VVS患者晕厥自然再发无相关性。

Objective To analyze the correlation between induced syncope in head-up tilt test(HUTT)and recurrence of syncope in vasovagal syncope(VVS)patients by follow-up.Methods This study was based on the data from a total of 214 outpatients or inpatients with positive HUTT undergone in Ningbo First Hospital from April 2016 to June 2018 and diagnosed with VVS.Cases were divided into a non-syncope group(consciousness)and a syncope group(loss of consciousness).The baseline information,blood pressure and heart rate and arrhythmic events in HUTT and the Vasovagal Syncope International Study(VASIS)type incidence were analyzed and compared between the two groups.The recurrence rate of syncope was also compared between the two groups and among each VASIS type under the natural condition during follow up from 6 to 32 months.Results There were 118 cases in the non-syncope group and 96 cases in the syncope group.The rate of blood pressure values of 0/0 mmHg,abnormal electrocardiogram and the VASIS type 2B in the syncope group were significantly higher than that in the non-syncope group(80.2%vs.66.9%,18.8%vs.8.5%,7.3%vs.0.8%,all P<0.05).However,there was no statistically significant difference in the rate of syncope recurrence between the two groups(25.5%vs.24.7%,P>0.05)or between the VASIS positive type(type 1,13.2%vs.7.8%,type 3,12.2%vs.13.0%,type 1+type 2,13.2%vs.11.7%,all P>0.05),and there was no recurrence of syncope in VVS patients with type 2 in the non-syncope group.Binary logistics regression analysis showed that all possible related factors diabetes(OR=0.530),basal heart rate(OR=0.999),natural course of disease(OR=1.518),abnormal electrocardiogram(OR=0.774),VASIS 1(OR=0.586),VASIS 2A(OR=0.374),VASIS 2B(OR=0.798),VASIS 3(OR=1.000),blood pressure 0/0 mmHg(OR=0.662),duration of blood pressure drop(OR=1.014)could not predict spontaneous recurrence of syncope(P>0.05).Conclusion There was no correlation between induced syncope in HUTT and spontaneous recurrence of syncope in VVS patients with positive HUTT.