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; 李红霞; 李雪迎; 唐朝枢; 金红芳; 杜军保

doi:10.19723/j.issn.1671-167X.2019.03.007

北京大学学报（医学版） >

2019 , Vol. 51 >Issue 3: 414 - 421

DOI: https://doi.org/10.19723/j.issn.1671-167X.2019.03.007

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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 ,
李红霞 ,
李雪迎 ,
唐朝枢 ,
金红芳 ,
杜军保

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^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

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。

收稿日期: 2019-03-12

网络出版日期: 2019-06-26

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

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

Chun-yan TAO ,
Hong-xia LI ,
Xue-ying LI ,
Chao-shu TANG ,
Hong-fang JIN ,
Jun-bao DU

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^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 date: 2019-03-12

Online 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

本文引用格式

陶春燕 , 李红霞 , 李雪迎 , 唐朝枢 , 金红芳 , 杜军保 . 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[J]. 北京大学学报（医学版）, 2019 , 51(3) : 414 -421 . DOI: 10.19723/j.issn.1671-167X.2019.03.007

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

参考文献

[1]	Goodman BP . Evaluation of postural tachycardia syndrome (POTS)[J]. Auton Neurosci, 2018,215:12-19.
[2]	Johnson JN, Mack KJ, Kuntz NL , et al. Postural orthostatic tachycardia syndrome: a clinical review[J]. Pediatr Neurol, 2010,42(2):77-85.
[3]	Stewart JM, Pianosi P, Shaban MA , et al. Postural hyperventilation as a cause of postural tachycardia syndrome: increased systemic vascular resistance and decreased cardiac output when upright in all postural tachycardia syndrome variants[J]. J Am Heart Assoc, 2018,7(13):e008854.
[4]	Li H, Han Z, Chen S, et al. Total peripheral vascular resistance, cardiac output ,plasma C-type natriuretic peptide level in children with postural tachycardia syndrome[J]. J Pediatr, 2015, 166(6): 1385- 1389. e1-2.
[5]	Zheng X, Chen Y, Du J . Recent advances in the understanding of the mechanisms underlying postural tachycardia syndrome in children: practical implications for treatment[J]. Cardiol Young, 2017,27(3):413-417.
[6]	Medow MS, Stewart JM . The postural tachycardia syndrome[J]. Cardiol Rev, 2007,15(2):67-75.
[7]	中华医学会儿科学分会心血管学组, 《中华儿科杂志》编辑委员会, 北京医学会儿科学分会心血管学组, 等. 2016儿童晕厥诊断指南(2016年修订版)[J]. 中华儿科杂志, 2016,54(4):246-250.
[8]	中华医学会儿科学分会心血管学组, 《中华儿科杂志》编辑委员会. 儿童晕厥诊断指南[J]. 中华儿科杂志, 2009,47(2):99-101.
[9]	Garland EM, Celedonio JE, Raj SR . Postural tachycardia syndrome: beyond orthostatic intolerance[J]. Curr Neurol Neurosci Rep, 2015,15(9):60.
[10]	Stewart JM, Medow MS, Glover JL , et al. Persistent splanchnic hyperemia during upright tilt in postural tachycardia syndrome[J]. Am J Physiol Heart Circ Physiol, 2006,290(2):H665-H673.
[11]	Fu Q, Vangundy TB, Galbreath MM , et al. Cardiac origins of the postural orthostatic tachycardia syndrome[J]. J Am Coll Cardiol, 2010,55(25):2858-2868.
[12]	Jacob G, Biaggioni I, Mosqueda-Garcia R , et al. Relation of blood volume and blood pressure in orthostatic intolerance[J]. Am J Med Sci, 1998,315(2):95-100.
[13]	Farquhar WB, Taylor JA, Darling SE , et al. Abnormal baroreflex responses in patients with idiopathic orthostatic intolerance[J]. Circulation, 2000,102(25):3086-3091.
[14]	Zhang Q, Liao Y, Tang C , et al. Twenty-four-hour urinary sodium excretion and postural orthostatic tachycardia syndrome[J]. J Pediatr, 2012,161(2):281-284.
[15]	蔺婧, 刘平, 王瑜丽 , 等. 儿童体位性心动过速综合征治疗随访的单中心研究[J]. 中华实用儿科临床杂志, 2015,30(13):983-987.
[16]	蔺婧, 刘平, 王瑜丽 , 等. 直立试验心率变化预测口服补液盐治疗体位性心动过速综合征的效果[J]. 中华儿科杂志, 2015,53(1):25-29.
[17]	Li H, Wang Y, Liu P , et al. Body mass index (BMI) is associated with the therapeutic response to oral rehydration solution in children with postural tachycardia syndrome[J]. Pediatr Cardiol, 2016,37(7):1313-1318.
[18]	Lu W, Yan H, Wu S , et al. Hemocytometric measures predict the efficacy of oral rehydration for children with postural tachycardia syndrome[J]. J Pediatr, 2017,187:220-224.
[19]	Raj SR, Robertson D . Blood volume perturbations in the postural tachycardia syndrome[J]. Am J Med Sci, 2007,334(1):57-60.
[20]	Karata? Z, Alp H, Sap F , et al. Usability of QTc dispersion for the prediction of orthostatic intolerance syndromes[J]. Eur J Paediatr Neurol, 2012,16(5):467-474.
[21]	Wang Y, Zhang C, Chen S , et al. Frequency domain indices of heart rate variability are useful for differentiating vasovagal syncope and postural tachycardia syndrome in children[J]. J Pediatr, 2019,207:59-63.
[22]	Lin J, Jin H, Du J . Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope[J]. Cardiol Young, 2014,24(5):792-796.
[23]	Altun B, Arici M . Salt and blood pressure: time to challenge[J]. Cardiology, 2006,105(1):9-16.
[24]	Hart EC, Joyner MJ, Wallin BG , et al. Sex, ageing and resting blood pressure: gaining insights from the integrated balance of neural and haemodynamic factors[J]. J Physiol, 2012,590(9):2069-2079.
[25]	Bevan JA . Control of peripheral vascular resistance: evidence based on the in vitro study of resistance arteries[J]. Clin Invest Med, 1987,10(6):568-572.

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