儿童血管迷走性晕厥时的血浆神经肽 Y 水平。
Plasma Neuropeptide Y Levels in Vasovagal Syncope in Children.
机构信息
Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
Department of Physiology and Pathophysiology, Health Sciences Centre, Peking University, Beijing 100083, China.
出版信息
Chin Med J (Engl). 2017 Dec 5;130(23):2778-2784. doi: 10.4103/0366-6999.219157.
BACKGROUND
Vasovagal syncope (VVS) is the most common cause of syncope in children. Neuropeptide Y (NPY) plays an important role in the regulation of blood pressure (BP), as well as myocardial contractility. This study aimed to explore the role of plasma NPY in VVS in children.
METHODS
Fifty-six children who were diagnosed with VVS (VVS group) using head-up tilt test (HUT) and 31 healthy children who were selected as controls (control group) were enrolled. Plasma NPY concentrations were detected. The independent t-test was used to compare the data of the VVS group with those of the control group. The changes in plasma NPY levels in the VVS group during the HUT, as well as hemodynamic parameters, such as heart rate (HR), BP, total peripheral vascular resistance (TPVR), and cardiac output (CO), were evaluated using the paired t-test. Furthermore, the correlations between plasma NPY levels and hemodynamic parameters were analyzed using bivariate correlation analysis.
RESULTS
The BP, HR, and plasma NPY (0.34 ± 0.12 pg/ml vs. 0.46 ± 0.13 pg/ml) levels in the supine position were statistically low in the VVS group compared to levels in the control group (all P < 0.05). Plasma NPY levels were positively correlated with the HR (Pearson, R = 0.395, P < 0.001) and diastolic BP (Pearson, R = 0.311, P = 0.003) when patients were in the supine position. When patients in the VVS group were in the supine position, elevated TPVR (4.6 ± 3.7 mmHg·min-1·L-1 vs. 2.5 ± 1.0 mmHg·min-1·L-1, respectively, P < 0.001; 1 mmHg = 0.133 kPa) and reduced CO (1.0 ± 0.7 L/min vs. 2.4 ± 1.3 L/min, respectively, P < 0.001) were observed in the positive-response period compared with baseline values. The plasma NPY levels were positively correlated with TPVR (Spearman, R = 0.294, P = 0.028) but negatively correlated with CO in the positive-response period during HUT (Spearman, R = -0.318, P = 0.017).
CONCLUSIONS
Plasma NPY may contribute to the pathogenesis of VVS by increasing the TPVR and decreasing the CO during orthostatic regulation.
背景
血管迷走性晕厥（VVS）是儿童晕厥最常见的原因。神经肽 Y（NPY）在血压（BP）调节以及心肌收缩力中发挥重要作用。本研究旨在探讨血浆 NPY 在儿童 VVS 中的作用。
方法
采用直立倾斜试验（HUT）诊断 56 例 VVS 患儿（VVS 组），选择 31 例健康儿童作为对照组（对照组）。检测血浆 NPY 浓度。采用独立 t 检验比较 VVS 组与对照组的数据。采用配对 t 检验评估 VVS 组在 HUT 期间的血浆 NPY 水平变化以及心率（HR）、BP、总外周血管阻力（TPVR）和心输出量（CO）等血流动力学参数。采用双变量相关分析分析血浆 NPY 水平与血流动力学参数的相关性。
结果
与对照组相比，VVS 组在仰卧位时的 BP、HR 和血浆 NPY（0.34±0.12 pg/ml 比 0.46±0.13 pg/ml）水平均较低（均 P<0.05）。当患者处于仰卧位时，血浆 NPY 水平与 HR（Pearson，R=0.395，P<0.001）和舒张压（Pearson，R=0.311，P=0.003）呈正相关。当 VVS 组患者处于仰卧位时，与基础值相比，阳性反应期的 TPVR（4.6±3.7 mmHg·min-1·L-1比 2.5±1.0 mmHg·min-1·L-1，均 P<0.001；1 mmHg=0.133 kPa）和 CO（1.0±0.7 L/min 比 2.4±1.3 L/min，均 P<0.001）升高。在 HUT 的阳性反应期，血浆 NPY 水平与 TPVR 呈正相关（Spearman，R=0.294，P=0.028），但与 CO 呈负相关（Spearman，R=-0.318，P=0.017）。
结论
在直立调节过程中，血浆 NPY 通过增加 TPVR 和降低 CO 可能有助于 VVS 的发病机制。
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