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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (3): 414-421. doi: 10.19723/j.issn.1671-167X.2019.03.007

• 论著 • 上一篇    下一篇

体位性心动过速综合征儿童及青少年在直立试验中血流动力学变化

陶春燕1,李红霞1,李雪迎2,唐朝枢3,金红芳1,杜军保1△()   

  1. 1. 北京大学第一医院儿科, 北京 100034
    2. 北京大学第一医院医学统计室, 北京 100034
    3. 北京大学基础医学院生理与病理生理学系, 北京 100191
    4. 教育部分子心血管学重点实验室, 北京 100191
  • 收稿日期:2019-03-12 出版日期:2019-06-18 发布日期:2019-06-26
  • 作者简介:杜军保,主任医师,教授,博士生导师,教育部长江学者特聘教授,国家杰出青年基金获得者,卫生部有突出贡献中青年专家,霍英东教育基金会全国优秀青年教师,担任《中华儿科杂志》总编,《科学通报》《世界儿科杂志》《中华医学杂志(英文版)》副总编,中国医师协会心血管医师分会儿童心血管专委会主任委员,中国医师协会儿科医师分会儿童晕厥专委会主任委员,亚太小儿心脏病协会理事。在国际上发表学术论文600余篇,其中在JACC等发表SCI论文160余篇,主持国家自然科学基金重点项目、973课题等50余项科研课题,曾经获教育部自然科学一等奖、教育部科技进步一等奖、北京市科技进步一等奖等9项奖励。
    他带领团队率先在我国创建了功能性心血管疾病诊断的关键技术——儿童直立倾斜试验,在国内外率先提出并开展了儿童硝酸甘油激发直立倾斜试验,研究并建立了儿童直立倾斜试验的判定指标体系。首先发现并报道我国儿童存在血管迷走性晕厥以及体位性心动过速综合征,首先发现儿童直立性高血压这一疾病,从而使我国儿童晕厥基础疾病的诊断率由不足10%提高至81.1%(宋庆龄儿科医学奖,2007),显著提高了儿童晕厥的诊断水平。率先提出了儿童晕厥个体化治疗策略,显著提高了儿童功能性心血管病的治疗水平(教育部科技进步奖一等奖,2007)。上述研究成果的核心内容被纳入欧洲(2009)、美国(2017)及加拿大 (2016)制定的晕厥指南。他先后主持并颁布了儿童晕厥诊治的3项中国指南及专家共识,牵头制定并颁布了儿童晕厥诊治的国际指南,使我国儿童功能性心血管疾病的研究和临床整体水平跻身于世界领先行列。
    开创性地揭示心血管系统存在含硫气体分子H2S及SO2的内源性生成体系,阐明其具有重要的心血管生理学及病理生理学意义,并发现其调节靶点,先后提出“内源性H2S及SO2是心血管调节的新的气体信号分子”(教育部提名国家自然科学奖一等奖),开创了内源性H2S及SO2生物学研究的新领域。
  • 基金资助:
    北京大学临床科学家计划专项 (BMU2019LCKXJ001)-中央高校基本科研业务费

Hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome

Chun-yan TAO1,Hong-xia LI1,Xue-ying LI2,Chao-shu TANG3,Hong-fang JIN1,Jun-bao DU1△()   

  1. 1. Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
    2. Department of Statistics, Peking University First Hospital, Beijing 100034, China
    3. Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
    4. Key Laboratory of Molecular Cardiovascular Science, the Ministry of Education, Beijing 100191, China
  • Received:2019-03-12 Online:2019-06-18 Published:2019-06-26
  • Supported by:
    Supported by the fundamental Research Funds for the Central Universities: Peking University Clinical Scientist Program (BMU2019LCKXJ001)

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摘要： 目的 分析体位性心动过速综合征(postural tachycardia syndrome, POTS)儿童及青少年直立试验过程中血流动力学变化及不同心脏指数(cardiac index, CI)患者血流动力学指标的差异。方法 回顾性分析26例POTS患者与12例健康对照者间直立试验过程中总外周血管阻力指数(total peripheral vascular resistance index, TPVRI)、心率和血压的变化,并比较两组间各指标变化趋势。根据每位POTS患者直立试验过程中CI变化趋势将患者分为CI降低组(14例)与CI未降低组(12例), 分析两组患者在直立试验过程中CI、TPVRI、心率、血压变化,并比较两组间各指标变化趋势。结果 POTS患者在直立试验过程中CI显著下降(F=6.936, P=0.001), 心率明显增快(F=113.926, P <0.001),收缩压明显降低(F=6.049, P <0.001),而TPVRI (F=2.031, P=0.138)和舒张压(F=2.018, P=0.113)无明显变化。健康对照组CI在直立后显著升高(F=3.646, P=0.016),同时心率明显增快(F=43.970, P<0.001),收缩压(F=4.043, P=0.020)和舒张压(F=8.627, P<0.001)均明显升高,TPVRI (F=1.688, P=0.190)无明显变化。POTS患者与健康对照组比较,CI (F=6.221, P=0.001)、心率(F=6.203, P<0.001)和收缩压(F=7.946, P<0.001)随时间变化趋势显著不同,而TPVRI和舒张压在两组间的变化趋势差异无统计学意义(P>0.05)。CI降低组与CI未降低组POTS患者在直立试验中CI变化趋势差异有统计学意义(F=14.723, P<0.001), 前者直立后收缩压明显降低(F=8.010, P<0.001),而后者却无明显变化(F=0.612, P=0.639), TPVRI、心率和舒张压在CI降低组与CI未降低组间随时间变化趋势差异无统计学意义(P>0.05)。年龄是POTS患者直立后CI呈下降趋势的独立影响因素(P=0.013, OR=2.233; 95% CI:1.183~4.216)。结论 POTS患者在直立试验过程中存在明显的血流动力学变化,不同患者心输出量变化可能不同,年龄是心输出量下降的独立影响因素。

关键词: 体位性心动过速综合征, 心脏指数, 总外周血管阻力指数, 儿童, 青少年

Abstract: Objective: To explore the hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome (POTS) and to compare hemodynamic parameters of POTS patients with decreased cardiac index (CI) and those with not-decreased CI.Methods: A retrospective study was conducted to show the trends of CI, total peripheral vascular resistance index (TPVRI), heart rate and blood pressure in standing-up test of 26 POTS patients and 12 healthy controls, and to compare them between the two groups. The POTS patients were divided into two groups based on CI decreasing or not in standing-up test, namely decreased CI group (14 cases) and not-decreased CI group (12 cases). The trends of the above mentioned hemodynamic parameters in standing-up test were observed and compared between decreased CI group and not-decreased CI group.Results: In standing-up test for all the POTS patients, CI (F=6.936, P=0.001) and systolic blood pressure (F=6.049, P<0.001) both decreased significantly, and heart rate increased obviously (F=113.926, P<0.001). However, TPVRI (F=2.031, P=0.138) and diastolic blood pressure (F=2.018, P=0.113) had no significant changes. For healthy controls, CI (F=3.646, P=0.016), heart rate (F=43.970, P<0.001), systolic blood pressure (F=4.043, P=0.020) and diastolic blood pressure (F=8.627, P<0.001) all increased significantly in standing-up test. TPVRI (F=1.688, P=0.190) did not change obviously. The changing trends of CI (F=6.221, P=0.001), heart rate (F=6.203, P<0.001) and systolic blood pressure (F=7.946, P<0.001) over time were significantly different between the patients and healthy controls, however, no difference was found in TPVRI and diastolic blood pressure (P > 0.05). Among the POTS patients, CI was significantly different between decreased CI group and not-decreased CI group (F=14.723, P<0.001). Systolic blood pressure of the former decreased obviously (F=8.010, P<0.001), but it did not change obviously in the latter (F=0.612, P=0.639). Furthermore, none of the changes of TPVRI, heart rate and diastolic blood pressure in standing-up test were significantly different between the two groups (P > 0.05). Age was an independent factor for decreased CI patients (P=0.013, OR=2.233; 95% CI, 1.183 to 4.216).Conclusion: POTS patients experience vital hemodynamic changes in standing-up test, part of them suffering from decreased CI, but others from not-decreased CI. Age is an independent factor for patients suffering from decreased CI.

Key words: Postural tachycardia syndrome, Cardiac index, Total peripheral vascular resistance index, Children, Adolescents

中图分类号: 

  • R725.4

表1

POTS患者与健康对照组一般特征比较"

Items POTS group (n=26) Control group (n=12) χ2 or t or Z value P value
Gender, male/female 11/15 6/6 0.197 0.658
Age/years 11.0±2.1 10.1±1.0 1.734 0.091
BMI/(kg/m2) 18.1±2.6 17.8±3.6 0.264 0.793
BSA/(m2) 1.30±0.20 1.18±0.20 1.513 0.139
Supine CI/[ L/(min·m2)] 2.13±0.71 1.79 (1.50, 3.03) -0.691 0.505
Supine TPVRI/[ mmHg·min/(L·m2)] 1.65 (0.50, 6.75) 1.98±0.60 -1.633 0.106
Supine HR/(/min) 74 (64, 100) 80±12 -0.881 0.379
Supine SBP/mmHg 109±13 105±11 0.903 0.372
Supine DBP/mmHg 63±10 61±7 0.670 0.507
ΔHR/(/min) 58±14 26±12 7.107 <0.001

图1

POTS患者与健康对照组在直立试验中血流动力学指标的变化"

图2

POTS患者直立试验中不同心脏指数变化情况"

表2

不同心脏指数变化趋势的POTS患者间一般特征比较"

Items Decreased CI group (n=14) Not-decreased CI group (n=12) χ2 or t or Z value P value
Gender, male/female 4/10 7/5 2.345 0.126
Age/years 12.1±1.6 9.7±1.9 3.444 0.002
BMI/(kg/m2) 18.6±2.6 17.5±2.5 1.166 0.255
BSA/(m2) 1.39±0.21 1.20±0.25 2.153 0.042
Supine CI/[ L/(min·m2)] 2.57±0.62 1.62±0.41 4.531 < 0.001
Supine TPVRI/[ mmHg·min/(L·m2)] 1.18±0.59 2.08 (0.68, 6.75) -2.701 0.007
Supine HR/(/min) 77±9 69 (66, 93) -1.211 0.226
Supine SBP/mmHg 111±13 106±12 0.948 0.353
Supine DBP/mmHg 65±10 62±10 0.887 0.384
ΔHR/(/min) 59±15 58±13 0.182 0.857
Symptom scores 6 (2,20) 4±2 -2.050 0.040

图3

POTS患者年龄与体表面积、平卧心脏指数、平卧外周血管阻力指数及症状评分的相关性"

表3

二元Logistic回归分析"

Variable B SE Wald OR (95% CI) P value
Age/years 0.803 0.324 6.144 2.233 (1.183 to 4.216) 0.013

图4

不同心脏指数变化趋势的POTS患者在直立试验中血流动力学指标的变化"

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ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
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Email： xbbjb2@bjmu.edu.cn

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