直立不耐受儿童和青少年直立倾斜试验反应类型与多种维生素水平的关系

The association between types of response to head-up tilt test and levels of various vitamins in children and adolescents with orthostatic intolerance

目的探讨直立不耐受儿童和青少年直立倾斜试验(HUTT)反应类型与多种维生素水平的关系。方法选取2018年11月至2019年4月因晕厥、头晕、头痛、胸闷等直立不耐受症状为主诉,在中南大学湘雅二医院儿童医学中心就诊的儿童和青少年65例[男35例,女30例,年龄5~14(10.5±2.0)岁],经病史询问、体格检查及必要的辅助检查,排除器质性心、脑血管疾病及其他系统疾病,根据HUTT结果分为HUTT阴性组和HUTT阳性组,比较2组患儿血清维生素A_(1)、B_(1)、B_(2)、B_(6)、B_(9)、B_(12)、C、E水平。计量资料采用独立样本t检验,计数资料采用χ^(2)检验进行统计学分析。结果1.HUTT阴性组32例(男18例,女14例),HUTT阳性组33例(男17例,女16例),其中血管迷走性晕厥28例,体位性心动过速综合征5例。HUTT阴性组和HUTT阳性组年龄、男女比例和体质量指数比较差异均无统计学意义(均P>0.05)。2.HUTT阳性组维生素B1水平显著低于HUTT阴性组[(77.43±16.70)nmol/L比(88.56±18.98)nmol/L,t=-2.513,P<0.05],2组维生素A_(1)、B_(2)、B_(6)、B_(9)、B_(12)、C、E比较差异均无统计学意义(均P>0.05)。结论HUTT阳性患儿存在维生素B1水平相对不足,提示维生素B1缺乏可能参与儿童和青少年神经介导性晕厥的发生。

Objective To analyze the association between the types of response to head-up tilt test(HUTT)and levels of various vitamins in children and adolescents with orthostatic intolerance.Methods Sixty-five cases of children and adolescents 35 males and 30 females aged 5-14(10.5±2.0)years old who complained orthostatic intolerance symptoms,including syncope,dizziness,headache,and chest tightness,in Children′s Medical Center,the Se-cond Xiangya Hospital,Central South University between November 2018 and April 2019,were enrolled.By comprehensive history,physical examination,and necessary laboratory testing,heart,cerebrovascular and other system diseases were excluded.According to HUTT result,these patients were divided into 2 groups,namely negative HUTT group and positive HUTT group.The serum levels of vitamin A1,B1,B2,B6,B9,B12,C,and E were compared between the 2 groups.Continuous data were analyzed by conducting t-test and categorical data were analyzed by performingχ^(2) test.Results(1)There were 32 cases(18 males and 14 females)in negative HUTT group and 33 cases(17 males and 16 females)in positive HUTT groups,with 28 cases of vaso vagal syncope and 5 cases of postural tachycardia syndrome.There were no significant differences in age,gender ratio,and body mass index between the negative HUTT group and positive HUTT group.(2)The serum level of vitamin B_(1) of positive HUTT group was lower than that of negative HUTT group[(77.43±16.70)nmol/L vs.(88.56±18.98)nmol/L,t=-2.513,P<0.05],while the levels of vitamin A_(1),B_(2),B_(6),B_(9),B_(12),C,and E had no significant differences between the two groups(all P>0.05).Conclusions Patients with positive responses to HUTT relatively lacked vitamin B1,suggesting the role of vitamin B1 in the pathophysiological process of neurally mediated syncope.