老年原发性高血压患者伴血管迷走性晕厥的相关研究

Head-up tilt table test in diagnosis of essential hypertension with vasovagal syncope in the elderly

目的观察直立倾斜试验(HUTT)对老年原发性高血压患者伴血管迷走性晕厥(VVS)阳性诊断情况。方法选择2017年9月~2019年9月于我院住院或门诊诊治的老年原发性高血压疑似VVS患者40例为高血压组,选择同期因晕厥或头晕、黑矇等症状就诊的临床无器质性疾病患者50例为对照组,2组均进行HUTT,包括基础倾斜试验(BTTT)和硝酸甘油倾斜试验(NTTT),记录HUTT阳性率,在HUTT前后检测血浆肾上腺素水平。结果高血压组与对照组HUTT阳性率比较,无显著差异(47.5%vs 54.0%,P=0.540),但高血压组BTTT阳性率显著高于对照组(30.0%vs 10.0%,P=0.016);NTTT阳性率显著低于对照组(17.5%vs 44.0%,P=0.043);HUTT阳性患者中,高血压组试验前肾上腺素水平显著高于对照组(P=0.000),2组试验后较试验前肾上腺素水平均显著升高(P=0.004,P=0.000),对照组试验后肾上腺素水平较高血压组明显升高(P=0.006)。结论部分老年原发性高血压患者出现的晕厥症状是由VVS所致,血浆肾上腺素在VVS发生过程中显著升高。

Objective To test the positive rate of head-up tilt table test(HUTT) in diagnosis of essential hypertension with vasovagal syncope(VVS) in the elderly.Methods Forty elderly essential hypertension patients with suspected VVS admitted to our hospital or treated in our outpatient department served as a hypertension group and 50 patients with no organic disease who visited our hospital due to syncope or dizziness and amaurosis during the same period served as a control group.The positive rate of HUTT,including BTTT and NTTT,in diagnosis of essential hypertension with VVS in the elderly was recorded.The plasma epinephrine level in two groups was measured before and after HUTT.Results No significant difference was detected in positive rate of HUTT in diagnosis of essential hypertension with VVS between the two groups(47.5% vs 54.0%,P=0.540).The positive rate of BTTT was significantly higher while that of NTTT was significantly lower in diagnosis of essential hypertension with VVS in hypertension group than in control group(30.0% vs 10.0%,P=0.016;17.5% vs 44.0%,P=0.043).The plasma epinephrine level was significantly higher in hypertension group than in control group before HUTT(P=0.000),in two groups after HUTT(P=0.004,P=0.000) and in control group than in hypertwnsion group after HUTT(P=0.006).Conclusion Syncope is caused by VVS in certain elderly essential hypertension patients and plasma epinephrine plays a significant role in VVS.