尿儿茶酚胺浓度评价β-阻滞剂对血管迷走性晕厥的疗效

Predicting Therapeutic Effect of a Beta-Blocker by Assessment of Catecholamine in Urine in Vasovagal Syncope Patients

目的:评价血管迷走性晕厥患者尿儿茶酚胺在β-阻滞剂疗效预测中的价值。方法:临床诊断为血管迷走性晕厥的患者经直立倾斜试验证实为血管抑制型纳入研究组,同期五晕厥的健康者为对照组。留置试验前24小时尿和试验前后4小时尿测定儿茶酚胺。研究组患者启用治疗β-阻滞剂康可,2.5mg qd,目标值为晨起时自测心率55～65次/分。达目标值后重复上述尿液收集和倾斜试验,继续康可治疗3个月。记录随访过程中的晕厥次数。正常对照不再重复该试验和尿儿茶酚胺测定。结果:共有32例受试者纳入本研究。其中试验组12例(女9,男3),对照组20例(女12例,男8例)。试验组治疗2周后重复倾斜试验仅1例结果阴性,然而治疗后3个月内的晕厥次数显著少于治疗前3个月(2.91次与1.43次)。试验组治疗前24小时尿NE、E、DA与对照组的比较,差异均无显著性。试验组用β-阻滞剂治疗前直立倾斜试验前后4小时尿儿茶酚胺与对照组比较,前者的NE含量显著少于后者[(2.52±0.85)mg与(4.85±1.99)mg,P<0.01]。经β-阻滞剂治疗后NE升高[(4.04±1.67)mg,P<0.01)。结论:直立倾斜试验未能预测β-阻滞剂预防血管迷走性晕厥疗效;倾斜试验前后尿NE含量测定有助于判定β-阻滞剂疗效。

Objectives:To evaluate the value of catecholamine assessment in urine in predicting clinical efficacy of beta-blockers in the patients with vasovagal syncope. Methods: Twelve patients with typical vasovagal syncope of vaso-suppressive characteristic and a positive tilt table test were classified as study group. Those without syncope and apparently normal ECG and ECHO were as control (20 cases). Catecholamine in 24 hour urine before tilt table test (TTT) and in 4 hour urine around the test were measured. All patients in the study group were treated with a beta-blocker CONOER. A repeat TTT was carried in all study patients and so was catecholamine. No repeat TTT and catecholamine assessment were carried in the controls. All patients were followed for 3 months for the recurrence of syncope. Results: Although only one in 12 patients revealed a negative TTT result in the repeat study, the frequency of syncope in 3 months after concor was reduced dramatically in comparison with pre-medication (2.91 vs 1.43). Norepinephrine (NE), epinephrine (E) and dopamine (DA) were not statistically different between the study group and the controls. NE in 4 hour urine before treatment in the study group was significantly lower than that in the controlf (2.52±0.85)mg vs (4.85±1.99)mg, P<0.01]. Two weeks after beta-blockade NE in 4 hour urine around TTT increased to 'near normal'. Conclusions: Beta-blocker therapy reduces vasovagal syncope events, which might be predicted by assessing NE level in 4 hour urine around TTT.