Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (5): 954-960. doi: 10.19723/j.issn.1671-167X.2022.05.024

Previous Articles     Next Articles

A 10-year retrospective analysis of spectrums and treatment options of orthostatic intolerance and sitting intolerance in children

Ya-xi CUI1,Jun-bao DU1,2,Qing-you ZHANG1,Ying LIAO1,Ping LIU1,Yu-li WANG1,Jian-guang QI1,Hui YAN1,Wen-rui XU1,Xue-qin LIU1,Yan SUN1,Chu-fan SUN1,Chun-yu ZHANG1,Yong-hong CHEN1,Hong-fang JIN1,*()   

  1. 1. Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
    2. Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing 100191, China
  • Received:2022-06-03 Online:2022-10-18 Published:2022-10-14
  • Contact: Hong-fang JIN E-mail:jinhongfang51@126.com
  • Supported by:
    the Cheung Kong Scholars (Young Scholars) Award Program, Ministry of Education, China(Q2017004);Beijing Municipal Science and Technology Project(Z171100001017253);the National High Level Hospital Clinical Research Funding (Multi-center Clinical Research Project of Peking University First Hospital)(2022CR59)

RICH HTML

 5   

PDF (PC)

105

Abstract:

Objective: To analyze the disease spectrums underlying orthostatic intolerance (OI) and sitting intolerance (SI) in Chinese children, and to understand the clinical empirical treatment options. Methods: The medical records including history, physical examination, laboratory examination, and imagological examination of children were retrospectively studied in Peking University First Hospital from 2012 to 2021. All the children who met the diagnostic criteria of OI and SI were enrolled in the study. The disease spectrums underlying OI and SI and treatment options during the last 10 years were analyzed. Results: A total of 2 110 cases of OI and SI patients were collected in the last 10 years, including 943 males (44.69%) and 1 167 females (55.31%) aged 4－18 years, with an average of (11.34±2.84) years. The overall case number was in an increasing trend over the year. In the OI spectrum, postural tachycardia syndrome (POTS) accounted for 826 cases (39.15%), followed by vasovagal syncope (VVS) (634 cases, 30.05%). The highest proportion of SI spectrum was sitting tachycardia (STS) (8 cases, 0.38%), followed by sitting hypertension (SHT) (2 cases, 0.09%). The most common comorbidity of OI and SI was POTS coexisting with STS (36 cases, 1.71%). The highest proportion of treatment options was autonomic nerve function exercise (757 cases, 35.88%), followed by oral rehydration salts (ORS) (687 cases, 32.56%), metoprolol (307 cases, 14.55%), midodrine (142 cases, 6.73%), ORS plus metoprolol (138 cases, 6.54%), and ORS plus midodrine (79 cases, 3.74%). The patients with POTS coexisting with VVS were more likely to receive pharmacological intervention than the patients with POTS and the patients with VVS (41.95% vs. 30.51% vs. 28.08%, χ2= 20.319, P < 0.01), but there was no significant difference in the proportion of treatment options between the patients with POTS and the patients with VVS. Conclusion: POTS and VVS in children are the main underlying diseases of OI, while SI is a new disease discovered recently. The number of children with OI and SI showed an increasing trend. The main treatment methods are autonomic nerve function exercise and ORS. Children with VVS coexisting with POTS were more likely to take pharmacological treatments than those with VVS or POTS only.

Key words: Children, Orthostatic intolerance, Sitting intolerance, Disease spectrum

CLC Number: 

  • R725

Figure 1

Changes in the number of children with OI or SI in different years"

Table 1

The disease spectrum of children with OI and SI in different years   n(%)"

Disease 2012 to 2016 2017 to 2021
Total Male Female Total Male Female
POTS 478 (49.64) 217 (45.40) 261 (54.60) 348 (30.34) 153 (43.97) 195 (56.03)
VVS 300 (31.15) 130 (43.33) 170 (56.67) 334 (29.12) 147 (44.01) 187 (55.99)
POTS + VVS 48 (4.98) 26 (54.17) 22 (45.83) 281 (24.50) 104 (37.01) 177 (62.99)
POTS + OHT 57 (5.92) 34 (59.65) 23 (40.35) 29 (2.53) 16 (55.17) 13 (44.83)
OHT 65 (6.75) 31 (47.69) 34 (52.31) 11 (0.96) 6 (54.55) 5 (45.45)
OH 8 (0.83) 4 (50.00) 4 (50.00) 18 (1.57) 9 (50.00) 9 (50.00)
VVS + OHT 5 (0.52) 4 (80.00) 1 (20.00) 22 (1.92) 14 (63.64) 8 (36.36)
POTS + VVS + OHT 2 (0.21) 1 (50.00) 1 (50.00) 20 (1.74) 8 (40.00) 12 (60.00)
POTS + VVS + STS - - - 26 (2.26) 7 (26.92) 19 (73.08)
POTS + STS - - - 36 (3.14) 19 (52.78) 17 (47.22)
VVS + STS - - - 8 (0.70) 4 (50.00) 4 (50.00)
STS - - - 8 (0.70) 5 (62.50) 3 (37.35)
SHT - - - 2 (0.17) 2 (100.00) 0 (0.00)
OHT + SHT - - - 1 (0.09) 1 (100.00) 0 (0.00)
POTS + OHT + STS + SHT - - - 3 (0.26) 1 (33.33) 2 (66.67)
Total 963 447 (46.42) 516 (53.58) 1 147 496 (43.24) 651 (56.76)

Table 2

The analysis of treatment options for VVS, POTS, and VVS coexisting with POTS   n(%)"

Treatment options POTS VVS POTS + VVS
Autonomic nervous function exercise 297 (35.96) 211 (33.28) 108 (32.83)
ORS 277 (33.53) 245 (38.64) 83 (25.23)
Metoprolol 140 (16.95) 60 (9.46) 42 (12.77)
Midodrine 43 (5.21) 55 (8.68) 34 (10.33)
ORS plus metoprolol 47 (5.69) 37 (5.84) 36 (10.94)
ORS plus midodrine 22 (2.66) 26 (4.10) 26 (7.90)
Total 826 634 329

Table 3

The analysis of proportion of pharmacologic and non-pharmacologic therapies for VVS, POTS, and VVS coexisting with POTS   n(%)"

Treatment options POTS VVS POTS + VVS
Non-pharmacological 574 (69.49) 456 (71.92) 191 (58.05)
Pharmacological 252 (30.51) 178 (28.08) 138 (41.95)
Total 826 634 329
1 魏红芳, 董湘玉, 肖要. 儿童直立不耐受与微观营养素和体质指数相关性研究进展[J]. 中国循证儿科杂志, 2019, 14 (6): 473.
doi: 10.3969/j.issn.1673-5501.2019.06.017
2 Anderson JB , Willis M , Lancaster H , et al. The evaluation and management of pediatric syncope[J]. Pediatr Neurol, 2016, 55, 6- 13.
doi: 10.1016/j.pediatrneurol.2015.10.018
3 Jug J , Lovrić Benčić M , Bradić L , et al. Depression, anxiety and quality of life in patients with syncope[J]. Psychiatr Danub, 2020, 32 (3/4): 442- 443.
4 Kara A , Doǧan MT . The psychopathology, depression, and anxiety levels of children and adolescents with vasovagal syncope: A case-control study[J]. J Nerv Ment Dis, 2021, 209 (8): 547- 551.
doi: 10.1097/NMD.0000000000001334
5 Zhao J , Han Z , Zhang X , et al. A cross-sectional study on upright heart rate and BP changing characteristics: Basic data for estab-lishing diagnosis of postural orthostatic tachycardia syndrome and orthostatic hypertension[J]. BMJ open, 2015, 5 (6): e007356.
doi: 10.1136/bmjopen-2014-007356
6 Lin J , Wang Y , Ochs T , et al. Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance[J]. Cardiol Young, 2015, 25 (1): 76- 80.
doi: 10.1017/S1047951113001601
7 尚丽丽, 彭宇阁, 刘佳, 等. 直立倾斜试验在儿童不明原因晕厥诊断中的应用[J]. 中国实用神经疾病杂志, 2019, 22 (18): 2026- 2031.
8 王利平, 杜忠东, 柴晓敏, 等. 舌下含服硝酸甘油直立倾斜试验对儿童血管迷走性晕厥的诊断价值[J]. 临床儿科杂志, 2006, 24 (5): 364- 366.
doi: 10.3969/j.issn.1000-3606.2006.05.007
9 张清友, 杜军保, 李万镇. 舌下含化硝酸甘油直立倾斜试验对儿童不明原因晕厥的诊断研究[J]. 中华儿科杂志, 2004, 42 (5): 371- 374.
doi: 10.3760/j.issn:0578-1310.2004.05.016
10 Tao C , Han Z , Yan Y , et al. Sitting-induced hemodynamic changes and association with sitting intolerance in children and adolescents: A cross-sectional study[J]. Sci Rep, 2020, 10 (1): 13921.
doi: 10.1038/s41598-020-70925-y
11 Wang C , Li Y , Liao Y , et al. 2018 Chinese pediatric cardiology society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents[J]. Sci Bull, 2018, 63 (23): 1558- 1564.
doi: 10.1016/j.scib.2018.09.019
12 宋婧媛, 王圆圆, 李红霞, 等. 儿童血管迷走性晕厥发病机制研究进展[J]. 中华实用儿科临床杂志, 2018, 33 (6): 478- 480.
doi: 10.3760/cma.j.issn.2095-428X.2018.06.020
13 Magkas N , Tsioufis C , Thomopoulos C , et al. Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations[J]. J Clin Hypertens (Greenwich), 2019, 21 (5): 546- 554.
doi: 10.1111/jch.13521
14 Zhang Q , Li J , Xie Y , et al. Orthostatic hypertension in children and adolescents with postural tachycardia syndrome[J]. J Trop Pediatr, 2014, 60 (6): 461- 466.
doi: 10.1093/tropej/fmu055
15 Brignole M , Moya A , de Lange FJ , et al. 2018 ESC guidelines for the diagnosis and management of syncope[J]. Eur Heart J, 2018, 39 (21): 1883- 1948.
doi: 10.1093/eurheartj/ehy037
16 蔺婧, 王瑜丽, 张清友, 等. 儿童青少年晕厥疾病谱近30年变化及卫生经济学分析单中心报告[J]. 中国实用儿科杂志, 2016, 31 (5): 350- 355.
17 杜军保, 李万镇. 基础直立倾斜试验对儿童不明原因晕厥的诊断研究[J]. 中华儿科杂志, 1997, 35 (6): 309- 312.
doi: 10.3760/j.issn:0578-1310.1997.06.008
18 张清友, 杜军保, 李万镇. 儿童体位性心动过速综合征的临床特征及随访研究[J]. 中华儿科杂志, 2005, 43 (3): 165- 169.
doi: 10.3760/j.issn:0578-1310.2005.03.002
19 钟睛. 儿童直立不耐受559例临床分析[D]. 济南: 山东大学, 2019.
20 Cai H , Wang S , Zou R , et al. Comparison of the active sitting test and head-up tilt test for diagnosis of postural tachycardia syndrome in children and adolescents[J]. Front Pediatr, 2021, 9, 691390.
doi: 10.3389/fped.2021.691390
21 Kanjwal K , Sheikh M , Karabin B , et al. Neurocardiogenic syncope coexisting with postural orthostatic tachycardia syndrome in patients suffering from orthostatic intolerance: A combined form of autonomic dysfunction[J]. Pacing Clin Electrophysiol, 2011, 34 (5): 549- 554.
doi: 10.1111/j.1540-8159.2010.02994.x
22 Tao C , Jin H , Du J . Management of orthostatic intolerance in children: the state of the art[J]. World J Pediatr, 2020, 16 (6): 543- 548.
doi: 10.1007/s12519-019-00329-0
23 Kaufmann H , Norcliffe-Kaufmann L , Palma JA . Baroreflex dysfunction[J]. N Engl J Med, 2020, 382 (2): 163- 178.
doi: 10.1056/NEJMra1509723
24 Iacoviello M , Guida P , Forleo C , et al. Impaired arterial baroreflex function before nitrate-induced vasovagal syncope during head-up tilt test[J]. Europace, 2008, 10 (10): 1170- 1175.
doi: 10.1093/europace/eun217
25 肖要, 张小华, 魏红芳, 等. 儿童直立不耐受发病机制研究进展[J]. 兰州大学学报(医学版), 2021, 47 (6): 82- 88.
26 Mitro P , Mudráková K , Micková H , et al. Hemodynamic parameters and heart rate variability during a tilt test in relation to gene polymorphism of renin-angiotensin and serotonin system[J]. Pacing Clin Electrophysiol, 2008, 31 (12): 1571- 1580.
doi: 10.1111/j.1540-8159.2008.01228.x
27 Stewart JM , Medow MS , Sutton R , et al. Mechanisms of vasovagal syncope in the young: reduced systemic vascular resistance versus reduced cardiac output[J]. J Am Heart Assoc, 2017, 6 (1): e004417.
doi: 10.1161/JAHA.116.004417
28 Bai W , Chen S , Jin H , et al. Vascular dysfunction of postural tachycardia syndrome in children[J]. World J Pediatr, 2018, 14 (1): 13- 17.
doi: 10.1007/s12519-017-0104-8
29 Mosqueda-Garcia R , Furlan R , Tank J , et al. The elusive pathophysiology of neurally mediated syncope[J]. Circulation, 2000, 102 (23): 2898- 2906.
doi: 10.1161/01.CIR.102.23.2898
30 Liao Y , Du J . Pathophysiology and individualized management of vasovagal syncope and postural tachycardia syndrome in children and adolescents: An update[J]. Neurosci Bull, 2020, 36 (6): 667- 681.
doi: 10.1007/s12264-020-00497-4
[1] Tao MA,Yan-hui LI,Man-man CHEN,Ying MA,Di GAO,Li CHEN,Qi MA,Yi ZHANG,Jie-yu LIU,Xin-xin WANG,Yan-hui DONG,Jun MA. Associations between early onset of puberty and obesity types in children: Based on both the cross-sectional study and cohort study [J]. Journal of Peking University (Health Sciences), 2022, 54(5): 961-970.
[2] YAN Hui,PANG Lu,LI Xue-ying,YANG Wen-shuang,JIANG Shi-ju,LIU Ping,YAN Cun-ling. Incidence and cause of abnormal cholesterol in children aged 2-18 years in a single center [J]. Journal of Peking University (Health Sciences), 2022, 54(2): 217-221.
[3] CHEN Man-man,YANG Zhao-geng,SU Bin-bin,LI Yan-hui,GAO Di,MA Ying,MA Tao,DONG Yan-hui,MA Jun. Analysis on the law of height growth spurt in adolescence of children and adolescents in Zhongshan City [J]. Journal of Peking University (Health Sciences), 2021, 53(3): 506-510.
[4] Chun-yan TAO,Hong-xia LI,Xue-ying LI,Chao-shu TANG,Hong-fang JIN,Jun-bao DU. Hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome [J]. Journal of Peking University(Health Sciences), 2019, 51(3): 414-421.
[5] LU Jin-hui, QIAN Jun, LIU He, ZHU Jun-xia. Clinical study on autologus platelet-rich fibrin aided revascularization of immature permanent teeth [J]. Journal of Peking University(Health Sciences), 2018, 50(4): 672-679.
[6] WU Peng-hui, XIE Yao, ZHAO Wei-hong, HUA Ying, SUN Qing, LI Shuo, WU Ye, LU Xin-tian. Clinical characteristics analysis of children with reversible posterior leukoen-cephalopathy syndrome during the treatment of hematological tumor [J]. Journal of Peking University(Health Sciences), 2018, 50(4): 662-665.
[7] CHEN Tian-qi, DONG Bin, ZHANG Wen-jing, GAO Di-si, DONG Yan-hui, MA Jun, MA Ying-hua. Association between speed and endurance performance with sleep duration in children and adolescents [J]. Journal of Peking University(Health Sciences), 2018, 50(3): 429-435.
[8] DONG Yan-hui, SONG Yi, DONG Bin, ZOU Zhi-yong, WANG Zheng-he, YANG Zhao-geng, WANG Xi-jie, LI Yan-hui, MA Jun. Association between the blood pressure status and nutritional status among Chinese students aged 7-18 years in 2014： based on the national blood pressure reference for Chinese children and adolescents [J]. Journal of Peking University(Health Sciences), 2018, 50(3): 422-428.
[9] WANG Nan， ZHAO Yu-ming. Retrospective study of dental treatment under general anesthesia of 62 disabled children and adolescents [J]. Journal of Peking University(Health Sciences), 2018, 50(2): 293-299.
[10] LIAO Ying, ZHANG Qing-you, LI Hong-xia, WANG Yu-li, LIU Ping, DU Jun-bao. Co-morbidity of vasovagal syncope and postural tachycardia syndrome with allergic diseases in children [J]. Journal of Peking University(Health Sciences), 2017, 49(5): 783-788.
[11] XU Wen-rui, LIAO Ying, JIN Hong-fang, ZHANG Qing-you, TANG Chao-shu, DU Jun-bao. Progress in diagnosis and management of syncope in children [J]. Journal of Peking University(Health Sciences), 2017, 49(5): 756-759.
[12] DONG Yan-hui, WANG Zheng-he, YANG Zhao-geng, WANG Xi-jie, CHEN Yan-jun, ZOU Zhi-yong, MA Jun. Epidemic status and secular trends of malnutrition among children and adolescents aged 7-18 years from 2005 to 2014 in China [J]. Journal of Peking University(Health Sciences), 2017, 49(3): 424-432.
[13] MA De-Fu, ZHANG Yu-Mei, WANG Pei-Yu, YANG Shi-Shi, TUO Ya, SHENG Qing-Hai. Analysis for the blood mineral content of children aged 3 to 12 years in 7 cities and 2 towns in China [J]. Journal of Peking University(Health Sciences), 2014, 46(3): 379-382.
[14] QIN Feng, QIAN Sheng-qiang, YUAN Jiu-hong. Strategies for the treatment and prevention of priapism in children [J]. Journal of Peking University(Health Sciences), 2013, 45(6): 1001-1006.
[15] LI Jia-wei, ZHANG Qing-you, GAO Jie, JIN Hong-fang, DU Jun-bao. Significance of serum iron in the differential diagnosis between vasovagal syncope and postural orthostatic tachycardia syndrome in children [J]. Journal of Peking University(Health Sciences), 2013, 45(6): 923-927.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. Journal of Peking University(Health Sciences), 2001, 33(1): 50 -53 .
[2] . [J]. Journal of Peking University(Health Sciences), 2002, 34(2): 140 -143 .
[3] . [J]. Journal of Peking University(Health Sciences), 2010, 42(4): 476 -479 .
[4] . [J]. Journal of Peking University(Health Sciences), 2008, 40(2): 208 -210 .
[5] . [J]. Journal of Peking University(Health Sciences), 2008, 40(5): 459 -464 .
[6] . [J]. Journal of Peking University(Health Sciences), 2008, 40(5): 465 -470 .
[7] . [J]. Journal of Peking University(Health Sciences), 2003, 35(3): 274 -276 .
[8] . [J]. Journal of Peking University(Health Sciences), 2003, 35(6): 571 -575 .
[9] . [J]. Journal of Peking University(Health Sciences), 2004, 36(4): 414 -416 .
[10] . [J]. Journal of Peking University(Health Sciences), 2010, 42(4): 458 -460 .
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd