Kong Y J, Bian P, Yang Y N, Dong T, Niu S M, Yuan S J, Dong X Y
Department of Pediatric Cardiology, Second Hospital of Lanzhou University, Lanzhou 730000, China.
Zhonghua Er Ke Za Zhi. 2022 Jun 2;60(6):557-561. doi: 10.3760/cma.j.cn112140-20211009-00854.
To investigate the correlation between vitamin D deficiency and the severity of symptoms in children with vasovagal syncope (VVS). A prospective study was conducted. One hundred and twenty-two children diagnosed with VVS by head up tilt test in Department of Pediatric Cardiology and 130 healthy children without symptoms who underwent physical examination in the outpatient department of Child Healthcare Department of Second Hospital of Lanzhou University from December 2019 to May 2021 were selected and assigned to VVS group and control group, respectively. According to the diagnostic criteria of vitamin D deficiency, children in the VVS group were assigned to three subgroups: non-vitamin D deficiency, vitamin D deficiency, and severe vitamin D deficiency. All children underwent detailed history taking, physical examination, and level determination of serum 25 (OH) D. Children in the VVS group were scored for orthostatic intolerance (OI) symptoms including 10 symptoms: syncope, dizziness, nausea, palpitation, headache, tremor, chest tightness, blurred vision, profuse perspiration, and attention deficit. The differences in the age, gender, body mass index, blood pressure, and serum 25 (OH) D levels between VVS group and control group, and the differences regarding the age, gender, body mass index, blood pressure, serum 25 (OH) D levels and symptom scores among the three VVS subgroups were compared. Comparisons were performed using independent sample test, ANOVA analysis, Chi square test and rank sum test. Pearson correlation analysis was used to analyze the correlation between serum 25 (OH) D levels and OI symptom scores in children with VVS. The serum 25 (OH) D levels were significantly lower in the VVS group than those in the control group ((31±11) . (46±10) nmol/L, =10.89, 0.001). Vitamin D deficiency was more frequent in the VVS group (73.0% (89/122) 24.6% (32/130), χ²=58.91, 0.001). There were significant differences among the severe vitamin D deficiency subgroup, vitamin D deficiency subgroup, and non-vitamin D deficiency subgroup regarding the serum 25 (OH) D levels ((9.8±0.4) . (26.6±6.5) . (45.8±5.9) nmol/L, =142.77, <0.001) and the OI symptom scores ((14±1) . (10±2) . (7±2) scores, =44.97, <0.001). The scores of syncope, nausea, profuse perspiration, blurred vision and dizziness among the severe vitamin D deficiency subgroup, vitamin D deficiency subgroup, and non-vitamin D deficiency subgroup were statistically significant (=9.01, 7.52, 12.11, 7.07 and 9.54, respectively, all <0.05). Pearson correlation analysis showed that the serum 25 (OH) D levels were negatively correlated with OI symptom scores in children with VVS (=-0.769, 0.001). VVS children have significant vitamin D deficiency. The severity of symptoms increases with decreasing of vitamin D level. Syncope, nausea, and profuse perspiration are more likely to occur in children with severe vitamin D deficiency, and dizziness and blurred vision are more likely to occur in children with vitamin D deficiency.
探讨维生素D缺乏与小儿血管迷走性晕厥（VVS）症状严重程度之间的相关性。进行了一项前瞻性研究。选取2019年12月至2021年5月在兰州大学第二医院儿科心脏病科通过直立倾斜试验诊断为VVS的122例患儿以及在儿童保健科门诊接受体检的130例无症状健康儿童，分别纳入VVS组和对照组。根据维生素D缺乏的诊断标准，将VVS组患儿分为三个亚组：非维生素D缺乏、维生素D缺乏和严重维生素D缺乏。所有儿童均进行详细的病史采集、体格检查及血清25（OH）D水平测定。对VVS组患儿的直立不耐受（OI）症状进行评分，包括晕厥、头晕、恶心、心悸、头痛、震颤、胸闷、视力模糊、大汗和注意力不集中10项症状。比较VVS组与对照组在年龄、性别、体重指数、血压及血清25（OH）D水平方面的差异，以及VVS三个亚组在年龄、性别、体重指数、血压、血清25（OH）D水平及症状评分方面的差异。采用独立样本t检验、方差分析、卡方检验和秩和检验进行比较。采用Pearson相关分析分析VVS患儿血清25（OH）D水平与OI症状评分之间的相关性。VVS组血清25（OH）D水平显著低于对照组（（31±11）.（46±10）nmol/L，t = 10.89，P < 0.001）。VVS组维生素D缺乏更为常见（73.0%（89/122）对24.6%（32/130），χ² = 58.91，P < 0.001）。严重维生素D缺乏亚组、维生素D缺乏亚组和非维生素D缺乏亚组在血清25（OH）D水平（（9.8±0.4）.（26.6±6.5）.（45.8±5.9）nmol/L，F = 142.77，P < 0.001）和OI症状评分（（14±1）.（10±2）.（7±2）分，F = 44.97，P < 0.001）方面存在显著差异。严重维生素D缺乏亚组、维生素D缺乏亚组和非维生素D缺乏亚组在晕厥、恶心、大汗、视力模糊和头晕评分方面差异有统计学意义（分别为F = 9.01、7.52、12.11、7.07和9.54，均P < 0.05）。Pearson相关分析显示，VVS患儿血清25（OH）D水平与OI症状评分呈负相关（r = -0.769，P < 0.001）。VVS患儿存在明显的维生素D缺乏。症状严重程度随维生素D水平降低而增加。严重维生素D缺乏的患儿更容易出现晕厥、恶心和大汗，维生素D缺乏的患儿更容易出现头晕和视力模糊。
