神经介导性晕厥患儿血压晨峰与血压昼夜节律的研究

Study on morning blood pressure surge and circadian rhythm of blood pressure in children with neurally mediated syncope

目的探讨神经介导性晕厥(NMS)患儿的血压晨峰(MBPS)及血压昼夜节律。方法收集2018年7月至2019年6月因不明原因晕厥、先兆晕厥等症状初次就诊于中南大学湘雅二医院的135例患儿资料,其中男74例,女61例;年龄3~16岁[(10.12±2.53)岁];行直立倾斜试验(HUTT)的当日完成24 h动态血压监测(24 h ABPM),分为HUTT阴性组和HUTT阳性组、杓形血压组和非杓形血压组,计算MBPS(睡-谷晨峰值)。结果1.一般资料:HUTT阳性组51例(血管迷走性晕厥27例,体位性心动过速综合征23例,直立性低血压1例)。HUTT阳性组中杓形血压22例(43.14%),非杓形血压29例;HUTT阴性组84例中杓形血压32例(38.10%),非杓形血压52例,2组间杓形血压占比比较差异无统计学意义(χ^(2)=1.305,P>0.05)。2.睡-谷晨峰值收缩压差值为1~45 mmHg[(15.97±8.03)mmHg](1 mmHg=0.133 kPa);睡-谷晨峰值舒张压差值为-6~43 mmHg[(14.05±7.97)mmHg]。HUTT阴性组与HUTT阳性组在睡-谷晨峰值收缩压差值及舒张压差值比较,差异均无统计学意义(均P>0.05)。3.杓形血压组年龄大于非杓形血压组[(10.72±2.20)岁比(9.72±2.66)岁],差异有统计学意义(t=2.288,P<0.05),杓形血压组日间平均收缩压[(110.20±8.33)mmHg比(105.54±7.51)mmHg,t=3.381,P<0.01]、晨峰收缩压[(109.99±10.19)mmHg比(106.63±8.71)mmHg,t=2.045,P<0.05]均高于非杓形血压组,杓形血压组夜间平均收缩压[(95.41±7.50)mmHg比(98.59±6.88)mmHg,t=2.540,P<0.01]、夜间平均舒张压[(48.61±4.52)mmHg比(52.28±4.65)mmHg,t=4.547,P<0.01]、夜间最低收缩压[(89.62±8.18)mmHg比(93.60±7.38)mmHg,t=2.940,P<0.01]、夜间最低舒张压[(44.99±5.32)mmHg比(49.01±5.54)mmHg,t=4.205,P<0.01]均低于非杓形血压组,杓形血压组夜间收缩压下降率[(13.42±2.68)%比(6.48±2.49)%,t=15.384,P<0.01]、夜间舒张压下降率[(19.98±4.92)%比(12.46±5.05)%,t=8.561,P<0.01]、睡-谷晨峰值收缩压差值[(20.37±8.30)mmHg比(13.03±6.36)mmHg,t=5.800,P<0.01]、睡-谷晨峰值舒张压差值[(16.91±8.06)mmHg比(12.13±7.36)mmHg,t=3.554,P<0.01]均高于非杓形血压组,差异均有统计学意义。结论NMS患儿夜间血压下降率和睡-谷晨峰血压差值均降低,存在血压昼夜节律紊乱。

Objective To investigate the circadian rhythm of blood pressure and morning blood pressure surge(MBPS)in children with neurally mediated syncope(NMS).Methods From July 2018 to June 2019,135 cases[aged 3-16 years old(10.12±2.53)years old,with 74 males and 61 females]with unexplained syncope,presyncope,and symptoms such as headache,dizziness,chest pain,and chest tightness were collected in the Second Xiangya Hospital,Central South University for the first time.The 24 hour ambulatory blood pressure monitoring(24 h ABPM)was completed on the same day of the head-up tilt test(HUTT).Patients were divided into HUTT negative and positive groups,and dippers and non-dippers groups.MBPS(sleep-trough surge)was calculated and compared respectively.Results(1)There were 51 patients in the HUTT positive group,including 27 patients with vasovagal syncope,23 patients with postural orthostatic tachycardia syndrome,and 1 patient with orthostatic hypotension.In HUTT positive group,there were 22 cases(43.14%)of dippers and 29 cases of non-dippers.There were 84 patients in the HUTT negative group,there were 32 cases(38.10%)of dippers and 52 cases of non-dippers.There were no statistical significances in the dipper proportion between HUTT positive and negative group(χ^(2)=1.305,P>0.05).(2)Sleep-trough systolic blood pressure(SBP)surge was 1-45 mmHg[(15.97±8.03)mmHg](1 mmHg=0.133 kPa),and sleep-trough diastolic blood pressure(DBP)surge was-6-43 mmHg[(14.05±7.97)mmHg].There were no statistical significances in sleep-trough surge between the HUTT negative and positive group(all P>0.05).(3)The age in the dipper group was higher than that in the non-dipper group[(10.72±2.20)years old vs.(9.72±2.66)years old,t=2.288,P<0.05].The daytime average SBP[(110.20±8.33)mmHg vs.(105.54±7.51)mmHg,t=3.381,P<0.01],and morning peak SBP[(109.99±10.19)mmHg vs.(106.63±8.71)mmHg,t=2.045,P<0.05]of the dipper group were higher than those of the non-dipper group.The nighttime average SBP[(95.41±7.50)mmHg vs.(98.59±6.88)mmHg,t=2.540,P<0.01],nighttime average DBP[(48.61±4.52)mmHg vs.(52.28±4.65)mmHg,t=4.547,P<0.01],nocturnal minimum SBP[(89.62±8.18)mmHg vs.(93.60±7.38)mmHg,t=2.940,P<0.01],and nocturnal minimum DBP[(44.99±5.32)mmHg vs.(49.01±5.54)mmHg,t=4.205,P<0.01]of the dipper group were lower than that of the non-dipper group.Nocturnal SBP reduction rate[(13.42±2.68)%vs.(6.48±2.49)%,t=15.384,P<0.01],nocturnal DBP reduction rate[(19.98±4.92)%vs.(12.46±5.05)%,t=8.561,P<0.01],sleep-trough SBP surge[(20.37±8.30)mmHg vs.(13.03±6.36)mmHg,t=5.800,P<0.01],and sleep-trough DBP surge[(16.91±8.06)mmHg vs.(12.13±7.36)mmHg,t=3.554,P<0.01]of the dipper group were higher than those of the non-dipper group.Conclusions Nocturnal blood pressure reduction and sleep-trough surge decreased in NMS children,and there is a circadian rhythm disorder of blood pressure.