Zhang J, Tang H N, Wang Y W, Li F, Cai H, Lin P, Zou R M, Wang C
Department of Pediatric Cardiovascular, Children's Medical Center,the Second Xiangya Hospital, Central South University, Changsha 410011, China.
Department of Laboratory Medicine, the Second Xiangya Hospital, Central South University, Changsha 410011, China.
Zhonghua Er Ke Za Zhi. 2022 Aug 2;60(8):792-797. doi: 10.3760/cma.j.cn112140-20220129-00098.
To investigate the predictive value of blood cell parameters in children with vasovagal syncope (VVS). In this case-control study, the VVS group included 111 patients with unexplained syncope or prodromata who were diagnosed with VVS by head-up tilt test in the Second Xiangya Hospital, Central South University from January 2018 to October 2020, and 111 healthy children were enrolled as control. The differences in blood cell parameters between the 2 groups were compared by test and Mann-Whitney test. Multivariate binary Logistic regression was used to analyze the independent correlation factors of VVS, and receiver operating characteristic (ROC) curve to explore the predictive value of blood cell parameters for diagnosing VVS. Sex composition ratios were consistent in the 2 groups (51 males 60 females), while the age of the VVS group was higher than that of the control group (11.0 (8.0, 12.5) 8.0 (7.0, 11.0) years, 4.390.001). Compared with the control group, VVS group had lower level of white blood cell (WBC) (6.0 (5.3, 7.1)×10 8.6 (6.7, 10.1)×10/L, -7.96, 0.001), lymphocyte (LY) (2.3 (1.9, 2.7)×10 4.0 (2.8, 6.3)×10/L, -8.49, 0.001), lymphocyte ratio (0.39 (0.33, 0.44) 0.52 (0.37, 0.69), -5.59, 0.001), monocyte (0.3 (0.3, 0.4)×10 0.4 (0.3, 0.6)×10/L, -6.19, 0.001), eosinophil (0.1 (0.1, 0.2)×10 0.2 (0.2, 0.4)×10/L, -5.75, 0.001), mean corpuscular-hemoglobin concentration (MCHC) ((328±12) (333±11) g/L, -3.27, 0.001) and blood platelet (263 (235, 313)×10 341 (295, 409)×10/L, -2.69, 0.001), but higher neutrophil ratio (0.53 (0.48, 0.58) 0.37 (0.22, 0.54), 5.860.001), hematocrit (0.39±0.04 0.37±0.04, 2.75, 0.006), mean corpuscular volume (MCV) (85 (82, 88) 81 (78, 84) fl, =5.56, 0.001), mean corpuscular hemoglobin (28 (27, 29) 27 (26, 28) pg, 3.390.001), red cell distribution width (39 (37, 41) 37 (36, 40) fl, =4.02, 0.001) and mean platelet volume (11 (10, 11) 10 (9, 11) fl, =2.81, 0.005) levels. After adjusting for confounding factors such as sex and age, LY (=0.42, 95% 0.29-0.62, 0.001), WBC (=0.75, 95% 0.59-0.95, 0.015), MCHC (=0.94, 95% 0.91-0.97, 0.001) were independent negative correlation factors of VVS, while MCV (=1.08, 95% 1.01-1.15, 0.021) was independent positive correlation factor. ROC curve showed that the combination of LY, WBC, MCV and MCHC had acceptable predictive value for the diagnosis of VVS, with area under curve of 0.88, sensitivity of 0.80, specificity of 0.83, and Youden index of 0.63. Compared with healthy children, the blood cell parameters usually change in those with VVS. Combination of LY, WBC, MCHC and MCV can facilitate the diagnosis of VVS in children with unexplained syncope or prodromata.
探讨血细胞参数对儿童血管迷走性晕厥（VVS）的预测价值。在这项病例对照研究中，VVS组包括111例不明原因晕厥或前驱症状的患者，这些患者于2018年1月至2020年10月在中南大学湘雅二医院通过直立倾斜试验被诊断为VVS，另选取111名健康儿童作为对照组。采用t检验和曼-惠特尼U检验比较两组血细胞参数的差异。运用多因素二元Logistic回归分析VVS的独立相关因素，并绘制受试者工作特征（ROC）曲线以探讨血细胞参数对诊断VVS的预测价值。两组性别构成比一致（男51例，女60例），而VVS组年龄高于对照组（11.0（8.0，12.5）岁对8.0（7.0，11.0）岁，P = 4.39，0.001）。与对照组相比，VVS组白细胞（WBC）水平较低（6.0（5.3，7.1）×10⁹/L对8.6（6.7，10.1）×10⁹/L，P = -7.96，0.001）、淋巴细胞（LY）（2.3（1.9，2.7）×10⁹/L对4.0（2.8，6.3）×10⁹/L，P = -8.49，0.001）、淋巴细胞比例（0.39（0.33，0.44）对0.52（0.37，0.69））、单核细胞（0.3（0.3，0.4）×10⁹/L对0.4（0.3，0.6）×10⁹/L，P = -6.19，0.001）、嗜酸性粒细胞（0.1（0.1，0.2）×10⁹/L对0.2（0.2，0.4）×10⁹/L，P = -5.75，0.001）、平均红细胞血红蛋白浓度（MCHC）（（328±12）g/L对（333±11）g/L，P = -3.27，0.001）和血小板（263（235，313）×10⁹/L对341（295，409）×10⁹/L，P = -2.69，0.001），但中性粒细胞比例（0.53（0.48，0.58）对0.37（0.22，0.54），P = 5.86，0.001）、血细胞比容（0.39±0.04对0.37±0.04，P = 2.75，0.006）、平均红细胞体积（MCV）（85（82，88）fl对81（78，84）fl，P = 5.56，0.001）、平均红细胞血红蛋白（28（27，29）pg对27（26，28）pg，P = 3.39，0.001）、红细胞分布宽度（39（37，41）fl对37（36，40）fl，P = 4.02，0.001）和平均血小板体积（11（10，11）fl对10（9，11）fl，P = 2.81，0.005）水平较高。校正性别和年龄等混杂因素后，LY（P = 0.42，95%CI 0.29 - 0.62，0.001）、WBC（P = 0.75，95%CI 0.59 - 0.95，0.015）、MCHC（P = 0.94，9�%CI 0.91 - 0.97，0.001）是VVS的独立负相关因素，而MCV（P = 1.08，95%CI 1.01 - 1.15，0.021）是独立正相关因素。ROC曲线显示，LY、WBC、MCV和MCHC联合对VVS诊断具有可接受的预测价值，曲线下面积为0.88，灵敏度为0.80，特异度为0.83，约登指数为0.63。与健康儿童相比，VVS患儿血细胞参数通常发生变化。LY、WBC、MCHC和MCV联合有助于不明原因晕厥或前驱症状儿童VVS的诊断。
