Park Kyoung-Ha, Han Sang Jin, Kim Hyun-Sook, Jo Sang Ho, Kim Sung-Ai, Park Woo Jung
Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Republic of Korea.
Cardiology. 2016;134(2):65-71. doi: 10.1159/000443519. Epub 2016 Mar 1.
The aim of this study was to investigate endothelial function and cardiovascular autonomic activity in patients with neurally mediated syncope (NMS).
Patients with a typical history of NMS were divided according to the result of a head-up tilt (HUT) test. There were 25 patients each in the HUT-positive (HUT+), HUT-negative (HUT-) and control groups. Flow-mediated dilation (FMD) and 24-hour ambulatory electrocardiography (AECG) were performed before the HUT tests.
The HUT+ group had a significantly higher FMD than that of the HUT- group and the control group (8.8 ± 3.3 vs. 6.4 ± 2.9%, p = 0.006, and 8.8 ± 3.3 vs. 5.7 ± 2.2%, p = 0.001, respectively). On a 24-hour AECG, the parasympathetic indexes of time domain, such as rMSSD and the pNN50, were significantly higher in the HUT+ group than in the HUT- group (39.0 ± 9.6 vs. 31.6 ± 9.6 ms, p = 0.016, and 16.5 ± 8.1 vs. 10.2 ± 7.2%, p = 0.002, respectively) and the control group (39.0 ± 9.6 vs. 28.9 ± 9.6%, p = 0.001 and 16.5 ± 8.1 vs. 8.7 ± 6.7%, p = 0.001, respectively). High-frequency spectra (parasympathetic activity) of the frequency domain showed similar results.
Not only parasympathetic activity, but also endothelial function may affect the results of HUT tests in patients with NMS.
本研究旨在调查神经介导性晕厥（NMS）患者的内皮功能和心血管自主神经活动。
根据直立倾斜试验（HUT）结果，将有典型NMS病史的患者分组。HUT阳性（HUT+）组、HUT阴性（HUT-）组和对照组各有25例患者。在HUT试验前进行血流介导的血管舒张（FMD）和24小时动态心电图（AECG）检查。
HUT+组的FMD显著高于HUT-组和对照组（分别为8.8±3.3% vs. 6.4±2.9%，p = 0.006；8.8±3.3% vs. 5.7±2.2%，p = 0.001）。在24小时AECG检查中，HUT+组的时域副交感神经指标，如rMSSD和pNN50，显著高于HUT-组（分别为39.0±9.6 vs. 31.6±9.6 ms，p = 0.016；16.5±8.1 vs. 10.2±7.2%，p = 0.002）和对照组（分别为39.0±9.6 vs. 28.9±9.6%，p = 0.001；16.5±8.1 vs. 8.7±6.7%，p = 0.001）。频域的高频频谱（副交感神经活动）显示了相似的结果。
在NMS患者中，不仅副交感神经活动，内皮功能也可能影响HUT试验结果。
