儿童神经介导性晕厥预后评估的生物学标志物

Biomarkers for prognostic assessment of neuromediated syncope in children

神经介导性晕厥(NMS)是自主神经反射介导的血管张力和心率变化引起的临床症状,平卧后可缓解,是儿童晕厥常见的原因。NMS分血管迷走性晕厥、体位性心动过速综合征、直立性低血压和直立性高血压等血流动力学类型。近年来儿童NMS预后评估的生物学标志物研究不断深入,心电学指标(QT离散度、心率变异性、加速度指数)、超声心动图指标(肱动脉介导的血管扩张、射血分数及短轴缩短率)、血液学指标(平均红细胞血红蛋白浓度、肾上腺髓质素前体中段肽、红细胞硫化氢、血浆去甲肾上腺素、血浆C型利钠肽、血浆合肽素)、直立倾斜试验指标(心率、心率差、心率血压乘积)、24 h尿钠、唾液皮质醇、压力反射敏感性、体重指数、直立位血压变化等对NMS预后评估效果较好。借助生物学标志物,可以针对NMS不同人群实现个体化治疗,改善长期预后。本文将对评估儿童NMS预后的生物学标志物进行综述。

Neuromediated syncope(NMS)is a clinical symptom caused by autonomic reflex mediated changes in vascular tone and heart rate,which can be relieved by supine position.It is a common cause of syncope in children.NMS is divided into vasovagal syncope,postural tachycardia syndrome,orthostatic hypotension and orthostatic hypertension according to hemodynamic types.In recent years,studies on biomarkers for prognostic assessment of children with NMS have continued to deepen.Electrocardiology indicators(QT dispersion,heart rate variability,acceleration index),echocardiography index(flow mediated dilation,ejection fraction,short axial shortening rate),hematology indexes(mean corpuscular hemoglobin concentration,midregional pro-adrenomedullin,erythrocytic hydrogen sulfide,plasma norepinephrine,plasma C-type natriuretic peptide,plasma copeptin),head-up tilt test index(heart rate,heart rate difference,rate pressure product),24-hour urinary sodium,salivary cortisol,barore reflex sensitivity,body mass index and orthostatic blood pressure changes have good prognostic effects on NMS.With the help of biomarkers,individualized treatment for different populations of NMS can be achieved to improve long-term prognosis.This review summarized the biomarkers used to assess the prognosis of children with NMS.