Tang Weiting, Gu Hui, Chen Bin, Hu Sheng, Fan Wenjie, You Yong
Department of Neurology, Affiliated 2nd Hospital of Hainan Medical University, Haikou, 570100, China.
Department of Neurology, First People's Hospital of Changde City, Changde, 415003, China.
Heliyon. 2024 Jul 18;10(15):e34724. doi: 10.1016/j.heliyon.2024.e34724. eCollection 2024 Aug 15.
Orthostatic intolerance (OI) is the inability to tolerate orthostatic stress during any postural change. The etiology of OI varies, and methods to obtain a specific diagnosis and plan appropriate treatment are important. The tools available within the Chinese context to swiftly identify orthostatic intolerance syndrome (OIS) are currently limited.
Patients with OI symptoms were included in this study and categorized into two groups based on the results of the supine-to-stand test. Those with abnormal test results were assigned to the OIS group, while those with normal test results were placed in the non-OIS group. We evaluated the internal consistency and predictive value of the Chinese Orthostatic Discriminant and Severity Scale (ODSS) by comparing patients' scores with their physiological measurements collected during orthostatic stress tests and the results of other available questionnaires, including the orthostatic Symptom Questionnaire and Orthostatic Grading Scale (OGS).
Patients with OIS scored significantly higher on all three questionnaires and showed significant differences in autonomic responses during orthostatic stress tests compared with non-OIS patients. Receiver operating characteristic curve analysis showed that the orthostatic score from the ODSS had moderate predictive value for the supine test (area under the curve [AUC] = 0.754). Further subgroup analysis revealed that the orthostatic score from the ODSS had uniquely high specificity and sensitivity for identifying patients with orthostatic hypotension with abnormal cerebral blood flow (OH-U, AUC = 0.919).
We conclude that the Chinese version of the ODSS has sufficient reliability and validity to distinguish patients with OIS and could possibly be used as a diagnostic tool for OH-U patients. Thus, the Chinese ODSS offers a beneficial screening tool for quickly assessing whether patients have OIS that requires further clinical assessment.
体位性不耐受（OI）是指在任何姿势改变过程中无法耐受体位性应激。OI的病因多种多样，获得特定诊断并制定适当治疗方案的方法很重要。目前，中国国内可用于快速识别体位性不耐受综合征（OIS）的工具有限。
有OI症状的患者纳入本研究，并根据仰卧位到站立位测试结果分为两组。测试结果异常的患者被分配到OIS组，而测试结果正常的患者被分到非OIS组。我们通过比较患者的得分与体位性应激测试期间收集的生理测量值以及其他可用问卷（包括体位性症状问卷和体位性分级量表（OGS））的结果，评估了中文版体位性判别与严重程度量表（ODSS）的内部一致性和预测价值。
与非OIS患者相比，OIS患者在所有三份问卷上的得分均显著更高，并且在体位性应激测试期间的自主神经反应存在显著差异。受试者工作特征曲线分析表明，ODSS的体位性得分对仰卧位测试具有中等预测价值（曲线下面积[AUC]=0.754）。进一步的亚组分析显示，ODSS的体位性得分在识别脑血流量异常的体位性低血压患者（OH-U，AUC=0.919）方面具有独特的高特异性和敏感性。
我们得出结论，中文版ODSS具有足够的可靠性和有效性来区分OIS患者，并且可能用作OH-U患者的诊断工具。因此，中文版ODSS提供了一种有益的筛查工具，可快速评估患者是否患有需要进一步临床评估的OIS。
