Qingyou Z, Junbao D, Jianjun C, Wanzhen L
Department of Pediatrics, The First Hospital, Peking University, Beijing 100034, P R China.
Pediatr Cardiol. 2004 Jul-Aug;25(4):360-4. doi: 10.1007/s00246-003-0513-4.
The aim of this study was to clarify the association of clinical characteristics of unexplained syncope with the outcome of the head-up tilt test (HUT) in children. A total of 47 patients with unexplained syncope were classified into two groups according to their outcomes of HUT: the positive response group and the negative response group. We reviewed their clinical data as well as the results of HUT and analyzed them with logistic regression method. The results showed that the incidence of positive responses to HUT was higher in girls than in boys (8/22 vs 10/7, p < 0.05). Compared with fainted children younger than 12 years of age, 12- to 16-year-old adolescents with unexplained syncope had a high positive outcome of HUT (30 vs 72.9%, p < 0.05). Compared with fainted children with negative response of HUT, children with positive response to HUT often had syncope in special circumstances (e.g., prolonged standing, anxiety and fright, and morning exercise), and they often had prodrome, such as pallor, lightheadedness, and nausea (28/30 vs 8/17, p < 0.05). However, the number and duration of syncopal spells did not relate to the positive responses to HUT. The logistic regression analysis showed that three factors significantly influenced the outcome of HUT: predisposing factors of syncope, prodrome of syncope, and age (p < 0.05; OR = 32.9434, 17.7281, and 2.7842, respectively). Hence, if pubertal girls with unexplained syncope had clear predisposing factors and prodromes, they were likely to have positive responses to HUT, and they were likely to be clinically considered as having vasovagal syncope.
本研究旨在阐明儿童不明原因晕厥的临床特征与直立倾斜试验（HUT）结果之间的关联。共有47例不明原因晕厥患者根据其HUT结果分为两组：阳性反应组和阴性反应组。我们回顾了他们的临床资料以及HUT结果，并采用逻辑回归方法进行分析。结果显示，HUT阳性反应的发生率女孩高于男孩（8/22 vs 10/7，p<0.05）。与12岁以下晕厥儿童相比，12至16岁不明原因晕厥的青少年HUT阳性结果更高（30% vs 72.9%，p<0.05）。与HUT阴性反应的晕厥儿童相比，HUT阳性反应的儿童常在特殊情况下（如长时间站立、焦虑和恐惧、晨练）发生晕厥，且常伴有前驱症状，如面色苍白、头晕和恶心（28/30 vs 8/17，p<0.05）。然而，晕厥发作的次数和持续时间与HUT阳性反应无关。逻辑回归分析显示，有三个因素显著影响HUT结果：晕厥的诱发因素、晕厥前驱症状和年龄（p<0.05；OR分别为32.9434、17.7281和2.7842）。因此，不明原因晕厥的青春期女孩若有明确的诱发因素和前驱症状，则可能对HUT有阳性反应，临床上可能被认为患有血管迷走性晕厥。
