Sun R, Kang Y Y, Zhang M M, Li A J, Lin Y, Shi L, Li X H
Department of Cardiology, Children's Hospital,Capital Institute of Pediatrics, Peking University Teaching Hospital, Beijing 100020,China.
Graduate School of Peking Union Medical College, Capital Institute of Pediatrics, Beijing 100020, China.
Zhonghua Er Ke Za Zhi. 2023 Feb 2;61(2):131-135. doi: 10.3760/cma.j.cn112140-20221217-01052.
To analyze the clinical characteristics and risk factors of malignant vasovagal syncope (VVS) in children. This was a case-control study. The data of 368 VVS patients who were treated in the Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics from June 2017 to December 2021 was collected and analyzed. They were divided into malignant VVS group and non-malignant VVS group according to the presence of sinus arrest, and then their demographic characteristics were compared. The children with malignant VVS and complete clinical information were recruited into the case group and were matched by age and sex (1∶4 ratio) with non-malignant VVS patients during the same period.Their clinical characteristics and lab tests were compared. Independent sample test, Mann Whitney or χ test was used for comparison between groups.Logistic regression was used to analyze the risk factors for malignant VVS in children. Eleven malignant VVS and 342 non-malignant VVS met the inclusion and exclusion critera. Eleven malignant VVS and 44 non-malignant children were recruited in the case-control study. Ten patients of the 11 malignant VVS had a cardiac arrest occurring at 35 (28, 35) minutes of the head-up tilt test, and the duration of sinus arrest was (9±5) s. One patient had syncope occurring while waiting for drawing blood, and the duration of sinus arrest was 3.4 s. The children with malignant vasovagal syncope were younger than non-malignant VVS patients (9 (7, 10) 12 (10, 14) years old, <0.05), and had higher mean corpuscular hemoglobin concentration (MCHC) and standard deviation of the mean cardiac cycle over 5-minute period within 24 hours ((347±9) (340±8) g/L, (124±9) (113±28) ms, both <0.05). Logistic regression analysis showed that MCHC was an independent risk factor for malignant VVS in pediatric patients (=1.13, 95% 1.02-1.26, =0.024). The onset age of malignant VVS was younger, with no other special clinical manifestations. MCHC was an independent risk factor for malignant VVS.
分析儿童恶性血管迷走性晕厥（VVS）的临床特征及危险因素。本研究为病例对照研究。收集并分析了2017年6月至2021年12月在首都儿科研究所附属儿童医院心内科接受治疗的368例VVS患者的数据。根据是否存在窦性停搏将其分为恶性VVS组和非恶性VVS组，然后比较两组的人口统计学特征。将具有完整临床资料的恶性VVS患儿纳入病例组，并按年龄和性别（1∶4比例）与同期非恶性VVS患者进行匹配。比较两组的临床特征和实验室检查结果。组间比较采用独立样本t检验、Mann-Whitney U检验或χ²检验。采用Logistic回归分析儿童恶性VVS的危险因素。11例恶性VVS和342例非恶性VVS符合纳入和排除标准。11例恶性VVS患儿和44例非恶性VVS患儿被纳入病例对照研究。11例恶性VVS患儿中，10例在直立倾斜试验35（28，35）分钟时发生心脏停搏，窦性停搏持续时间为（9±5）秒。1例在等待抽血时发生晕厥，窦性停搏持续时间为3.4秒。恶性血管迷走性晕厥患儿的年龄低于非恶性VVS患者（9（7，10）岁对12（10，14）岁，P<0.05），且平均红细胞血红蛋白浓度（MCHC）和24小时内5分钟平均心动周期标准差更高（（347±9）对（340±8）g/L，（124±9）对（113±28）ms，均P<0.05）。Logistic回归分析显示，MCHC是小儿恶性VVS的独立危险因素（β=1.13，95%CI 1.02-1.26，P=0.024）。恶性VVS起病年龄较小，无其他特殊临床表现。MCHC是恶性VVS的独立危险因素。
