Yi SeoYeon, Kong Young Hwa, Kim Sun Jun
Department of Pediatrics, Jeonbuk National University Medical School, Jeonju, Korea.
Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju, Korea.
J Clin Neurol. 2021 Jan;17(1):46-51. doi: 10.3988/jcn.2021.17.1.46.
The purpose of this study was to determine the effect of fludrocortisone in patients with pediatric vasovagal syncope (VVS).
This retrospective observational single-tertiary-center study based on chart reviews included 74 patients who were newly diagnosed with VVS in the head-up tilt-table test (HUTT). Some of the patients had been treated with fludrocortisone. All patients were assessed using a brain and cardiac workup before treatment to rule out the syncope being due to other causes, which resulted in seven of them being excluded: two for epilepsy and five for brain pathologies. The remaining 67 patients were analyzed. The effect of fludrocortisone was evaluated based on the results of a follow-up HUTT, with a response to the treatment considered to be present if there was a negative change at the follow-up HUTT. Univariate logistic regression were used for statistical analyses, with the criterion for significance being <0.05.
There were no significant differences in the characteristic of the patients between the no-medication (=39) and fludrocortisone (=28) groups, including age, sex, and duration of treatment. The recurrence rate of syncopal or presyncopal events was significantly lower in the fludrocortisone group (39.3%, 11 of 28) than in the no-medication group (64.1%, 25 of 39) (=0.044), as was the rate of negative change at the follow-up HUTT: 57.1% (16 of 28) and 28.2% (11 of 39), respectively (=0.017).
Our findings suggest that fludrocortisone is more effective than no medication in pediatric patients with VVS.
本研究旨在确定氟氢可的松对小儿血管迷走性晕厥（VVS）患者的疗效。
这项基于病历回顾的回顾性观察单中心研究纳入了74例在直立倾斜试验（HUTT）中初诊为VVS的患者。部分患者接受过氟氢可的松治疗。所有患者在治疗前均接受了脑部和心脏检查，以排除晕厥由其他原因引起，结果7例患者被排除：2例因癫痫，5例因脑部病变。对其余67例患者进行分析。根据随访HUTT的结果评估氟氢可的松的疗效，若随访HUTT出现阴性变化，则认为治疗有反应。采用单因素逻辑回归进行统计分析，显著性标准为<0.05。
未用药组（n = 39）和氟氢可的松组（n = 28）患者的特征，包括年龄、性别和治疗持续时间，均无显著差异。氟氢可的松组晕厥或晕厥前事件的复发率（39.3%，28例中的11例）显著低于未用药组（64.1%，39例中的25例）（P = 0.044），随访HUTT的阴性变化率也较低：分别为57.1%（28例中的16例）和28.2%（39例中的11例）（P = 0.017）。
我们的研究结果表明，氟氢可的松对小儿VVS患者的疗效优于未用药治疗。
