直立倾斜试验不同时间点心率和心率差与儿童及青少年体位性心动过速综合征发生的关系

The relationship between heart rate and heart rate difference at different time points in head-up tilt test and the occurrence of postural tachycardia syndrome in children and adolescents

目的:探讨直立倾斜试验(HUTT)不同时间点心率(HR)和心率差(HRD)与儿童及青少年体位性心动过速综合征(POTS)发生的关系。方法:收集2000年10月至2019年11月因不明原因晕厥或晕厥先兆在中南大学湘雅二医院儿童晕厥专科门诊就诊、并诊断为POTS的6-16岁儿童及青少年217例为POTS组。匹配同期在本院儿童保健专科门诊进行健康检查的6-16岁儿童及青少年73例为对照组。获取基线、HUTT 5 min、10 min的HR(HR0、HR5、HR10)及HUTT 5 min、10 min时HR与基线HR的差值即HRD(HRD5、HRD10)。结果:(1)HR5、HR10、HRD5、HRD10在POTS组高于对照组( P<0.05)。(2)单变量Logistic回归:HR5、HR10、HRD5、HRD10与发生POTS的风险之间存在关联( P<0.01)。(3)多变量Logistic回归:HRD5、HRD10分别每增加一个单位,发生POTS的风险分别增加27%( OR=1.27,95% CI1.16-1.36)和28%( OR=1.28,95% CI1.20-1.38),这是在分别调整了年龄、性别、HR10或HR5后的独立作用。 结论:HR和HRD与儿童及青少年POTS发生存在关联,但HUTT不同时间点的HR和HRD对发生POTS的效应值大小影响不大。

Objective To discuss the relationship between heart rate(HR)and heart rate differences(HRD)at different time points in head-up tilt test(HUTT)and the occurrence of postural tachycardia syndrome(POTS)in children and adolescents.Methods A total of 217 children and adolescents diagnosed as POTS,who complained of syncope or presyncope,were chosen as POTS group(aged 6 to 16 years).During the same period,73 healthy children and adolescents with matching gender and age were selected as control group.All subjects underwent HUTT from October 2000 to November 2019.Get HR(HR0,HR5,HR10)in baseline,HUTT 5 min and 10 min,HRD(HRD5,HRD10)of HR in HUTT 5 min and 10 min minus HR in baseline.Results(1)HR5,HR10,HRD5,and HRD10 were higher in the POTS group than those in the control group(P<0.05).(2)Univariate Logistic regression:There was a correlation between HR5,HR10,HRD5,HRD10 and the risk of POTS(P<0.01).(3)Multivariable Logistic regression:For each additional unit of HRD5 and HRD10,the risk of POTS increased by 27%(OR=1.27,95%CI1.16 to 1.36)and 28%(OR=1.28,95%CI1.20 to 1.38).Conclusion HR and HRD are related with the occurrence of POTS in children and adolescents,but HR and HRD at different time points of HUTT play the little role on the effect size of the occurrence of POTS.