血浆催乳素及皮质醇与儿童血管迷走性晕厥的相关性

Correlation of plasma prolactin and cortisol with vasovagal syncope in children

目的分析血管迷走性晕厥(VVS)患儿直立倾斜试验(HUT)中血浆催乳素(PRL)及皮质醇(Cor)的变化,探讨二者与VVS的相关性。方法回顾性选取2019年5月至2020年5月首都儿科研究所附属儿童医院完善HUT阳性确诊为VVS的75例患儿设为VVS组,选取同期HUT阴性的29例健康儿童设为健康对照组。采用无创连续血压监测仪实时监测心率(HR)、收缩压(SBP)及舒张压(DBP),比较HUT平卧位及HUT阳性反应时HR、SBP及DBP的变化。采用电化学发光法测定HUT平卧位及HUT阳性反应时的PRL及Cor水平,计算HUT平卧位及HUT阳性时PRL及Cor的变化差值(ΔPRL、ΔCor)。组间比较采用独立样本t检验及Mann-Whitney秩和检验,采用受试者工作特征曲线(ROC)分析ΔPRL对VVS的预测价值。结果VVS组与健康对照组年龄、性别、体质量指数、血电解质比较,差异均无统计学意义(均P>0.05);VVS组亚型间(血管抑制型、混合型、心脏抑制型)晕厥频率、晕厥病程比较,差异均无统计学意义(均P>0.05)。VVS组HUT后PRL高于健康对照组[36.23(22.08,61.97)μg/L比11.47(8.00,23.25)μg/L],差异有统计学意义(Z=-5.40,P<0.01)。VVS组HUT前后ΔPRL、ΔCor均高于健康对照组[25.36(9.92,48.93)μg/L比-0.10(-2.67,9.32)μg/L;(84.4±43.6)μg/L比(57.6±64.6)μg/L],差异均有统计学意义(Z=-5.39;t=-2.44,均P<0.05)。HUT阳性反应时PRL与SBP、DBP均呈负相关(r=-0.46、-0.45,均P<0.01);尤其在VVS组(r=-0.38、-0.24,均P<0.05)。VVS组HUT前后ΔCor与SBP呈负相关(r=-0.25,P<0.05)。ROC曲线显示,ΔPRL预测VVS的曲线下面积为0.842,ΔPRL以4.03μg/L为界值,对预测HUT阳性反应的判断较好,敏感性为89.3%,特异性为72.4%。结论VVS患儿晕厥发作时血浆PRL及Cor升高,其中血浆PRL与血压下降有关。VVS患儿HUT阳性反应时血浆PRL的增高水平与血压有关,ΔCor与SBP有关,血浆PRL、Cor可能参与VVS的发病过程;ΔPRL对VVS有诊断价值。

Objective To investigate the changes of plasma prolactin(PRL)and cortisol(Cor)in the head up tilt test(HUT)in children with vasovagal syncope(VVS),and their correlation with VVS.Methods From May 2019 to May 2020,75 children diagnosed as VVS through positive HUT in the Children′s Hospital,Capital Institute of Pediatrics were retrospectively recruited as VVS group,while 29 healthy children with negative HUT during the same period were collected in healthy control group.Heart rate(HR)and blood pressure[systolic and diastolic blood pressure(SBP,DBP)]were monitored using a noninvasive continuous blood pressure monitor.The changes of HR,SBP and DBP were analyzed and their differences between the supine position and positive reaction of HUT were compared.The contents of PRL and Cor in the supine position and positive reaction of HUT were measured using the electrochemiluminescence,and their changes(ΔPRL andΔCor)were calculated.Differences between groups were analyzed by the two-tailed Student′s t-test or the Mann-Whitney test.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value ofΔPRL on VVS.Results There were no significant differences in the age,gender,body mass index,blood electrolyte,syncope frequency and syncope course between VVS group and healthy control group(all P>0.05).There was no significant difference in syncope frequency and course of syncope among subtypes of VVS group(vasodepressor syncope,mixed syncope,cardioinhibitory syncope)(all P>0.05).Compared with healthy control group,PRL after HUT was significantly higher in VVS group[36.23(22.08,61.97)μg/L vs.11.47(8.00,23.25)μg/L,Z=-5.40,P<0.01].BothΔPRL[25.36(9.92,48.93)μg/L vs.-0.10(-2.67,9.32)μg/L,Z=-5.39,P<0.01]andΔCor[(84.4±43.6)μg/L vs.(57.6±64.6)μg/L,t=-2.44,P<0.05]were significantly higher in VVS group than those of healthy control group.PRL at HUT positive reaction was negatively correlated with SBP and DBP(r=-0.46,-0.45,all P<0.01).In VVS group,PRL at HUT positive reaction was negatively correlated with SBP(r=-0.38,-0.24,all P<0.05).In VVS group,ΔCor after HUT was negatively correlated with SBP(r=-0.25,P<0.05).ROC curves revealed that the cut-off value ofΔPRL in predicting HUT was 4.03μg/L,with the sensitivity of 89.3%and specificity of 72.4%.Conclusions Plasma PRL and Cor increase during syncope in VVS children,and plasma PRL is correlated with blood pressure drop.The increased plasma level of PRL in VVS children with positive HUT is correlated with blood pressure,andΔCor is correlated with SBP.Plasma PRL and Cor may be involved in the pathogenesis of VVS andΔPRL presents the diagnostic potential of VVS in children.