Song Jinqing, Tao Chunyan, Chen Guozhen, Chen Selena, Xu Wenrui, Du Junbao, Yang Yanling, Huang Yaqian
Department of Pediatrics, Peking University First Hospital, Beijing, China.
Department of Pediatrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
Front Pediatr. 2020 Mar 11;8:98. doi: 10.3389/fped.2020.00098. eCollection 2020.
To investigate if the low sodium intake is associated with the plasma carnitine and acylcarnitine profile in children with vasovagal syncope (VVS). Twenty-six children suffering from VVS were recruited in the present study and divided into a group of low urinary sodium excretion or a group of normal urinary sodium excretion according to the excretion of 24-h urinary sodium <3 or 3-6 g, respectively. The excretion of 24-h urinary sodium was detected with ion-selective electrode approach. Plasma carnitine and acylcarnitine concentrations were measured with tandem mass spectrometry. Each participant completed the head-up tilt test. The demographics, clinical characteristics, hemodynamic parameters and plasma carnitine and acylcarnitine concentrations were compared between the two groups. A bivariate correlation between plasma acylcarnitine profiles and the excretion of 24-h urinary sodium was conducted with Spearman's correlation coefficients. Of the enrolled VVS patients, 14 patients were assigned to the group of low urinary sodium excretion and the remaining 12 patients were assigned to the group of normal urinary sodium excretion. Symptoms of fatigue were more prevalent in the group of low urinary sodium excretion than in the group of normal urinary sodium excretion ( = 0.009). Aside from fatigue, no other differences in the demographics, clinical characteristics or hemodynamic parameters during the head-up tilt test were found between the two groups ( > 0.05). Concentrations of plasma tiglylcarnitine (C5:1), hydroxyhexadecanoylcarnitine (C16OH), hydroxyoctadecanoylcarnitine (C18OH), and carnitine C22 were significantly higher in the group of low urinary sodium excretion than in the group of normal urinary sodium excretion (all values = 0.048); moreover, they were all negatively correlated with 24-h urinary sodium levels (all -values = 0.016). There were no differences between the two groups in other acylcarnitines or free carnitine. Reduced excretion of 24-h urinary sodium is associated with a disturbed plasma acylcarnitine profile in children with VVS. The findings suggest that restricted sodium intake-induced disturbance of plasma acylcarnitines and related cellular energy metabolism might be involved in the pathogenesis of VVS in children.
探讨低钠摄入是否与血管迷走性晕厥（VVS）患儿的血浆肉碱和酰基肉碱谱相关。本研究招募了26例VVS患儿，根据24小时尿钠排泄量分别<3g或3 - 6g分为低尿钠排泄组或正常尿钠排泄组。采用离子选择性电极法检测24小时尿钠排泄量。用串联质谱法测定血浆肉碱和酰基肉碱浓度。每位参与者均完成直立倾斜试验。比较两组的人口统计学、临床特征、血流动力学参数以及血浆肉碱和酰基肉碱浓度。用Spearman相关系数对血浆酰基肉碱谱与24小时尿钠排泄量进行双变量相关性分析。在纳入的VVS患者中，14例被分配到低尿钠排泄组，其余12例被分配到正常尿钠排泄组。低尿钠排泄组疲劳症状比正常尿钠排泄组更普遍（P = 0.009）。除疲劳外，两组在人口统计学、临床特征或直立倾斜试验期间的血流动力学参数方面未发现其他差异（P>0.05）。低尿钠排泄组血浆中乙酰基肉碱（C5:1）、羟基十六烷酰肉碱（C16OH）、羟基十八烷酰肉碱（C18OH）和肉碱C22的浓度显著高于正常尿钠排泄组（所有P值 = 0.048）；此外，它们均与24小时尿钠水平呈负相关（所有r值 = 0.016）。两组在其他酰基肉碱或游离肉碱方面无差异。24小时尿钠排泄减少与VVS患儿血浆酰基肉碱谱紊乱有关。研究结果表明，钠摄入受限引起的血浆酰基肉碱紊乱及相关细胞能量代谢可能参与了儿童VVS的发病机制。
