van Campen C Linda M C, Rowe Peter C, Visser Frans C
Stichting CardioZorg, Hoofddorp, Netherlands.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Front Pediatr. 2023 May 12;11:1169447. doi: 10.3389/fped.2023.1169447. eCollection 2023.
During a standard 70-degree head-up tilt test, 90% of adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) develop an abnormal reduction in cerebral blood flow (CBF). A 70-degree test might not be tolerated by young ME/CFS patients because of the high incidence of syncopal spells. This study examined whether a test at 20 degrees would be sufficient to provoke important reductions in CBF in young ME/CFS patients.
We analyzed 83 studies of adolescent ME/CFS patients. We assessed CBF using extracranial Doppler measurements of the internal carotid and vertebral arteries supine and during the tilt. We studied 42 adolescents during a 20 degree and 41 during a 70 degree test.
At 20 degrees, no patients developed postural orthostatic tachycardia (POTS), compared to 32% at 70 degrees ( = 0.0002). The CBF reduction during the 20 degree tilt of -27(6)% was slightly less than during the reduction during a 70 degree test [-31(7)%; = 0.003]. Seventeen adolescents had CBF measurements at both 20 and 70 degrees. The CBF reduction in these patients with both a 20 and 70 degrees test was significantly larger at 70 degrees than at 20 degrees ( < 0.0001).
A 20 degree tilt in young ME/CFS patients resulted in a CBF reduction comparable to that in adult patients during a 70 degree test. The lower tilt angle provoked less POTS, emphasizing the importance of using the 70 degree angle for that diagnosis. Further study is needed to explore whether CBF measurements during tilt provide an improved standard for classifying orthostatic intolerance.
在标准的70度头高位倾斜试验中，90%的肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）成人患者会出现脑血流量（CBF）异常减少。由于晕厥发作的发生率较高，年轻的ME/CFS患者可能无法耐受70度试验。本研究旨在探讨20度试验是否足以引发年轻ME/CFS患者的CBF显著减少。
我们分析了83项关于青少年ME/CFS患者的研究。我们使用仰卧位及倾斜过程中对颈内动脉和椎动脉进行颅外多普勒测量来评估CBF。我们在20度试验中研究了42名青少年，在70度试验中研究了41名青少年。
在20度时，没有患者出现体位性直立性心动过速（POTS），而在70度时这一比例为32%（P = 0.0002）。20度倾斜期间CBF减少-27（6）%，略低于70度试验期间的减少幅度[-31（7）%；P = （此处原文有误，推测为P = 0.003）]。17名青少年在20度和70度时都进行了CBF测量。这些在20度和70度试验中都进行测量的患者，其CBF减少在较大程度上在70度时比20度时更大（P < 0.0001）。
年轻ME/CFS患者进行20度倾斜时导致的CBF减少与成人患者在70度试验时相当。较低的倾斜角度引发的POTS较少，这强调了使用70度角度进行该诊断的重要性。需要进一步研究以探索倾斜期间的CBF测量是否为直立不耐受的分类提供了改进的标准。
