Milovanovic Branislav, Markovic Nikola, Petrovic Masa, Zugic Vasko, Ostojic Milijana, Dragicevic-Antonic Milica, Bojic Milovan
Institute for Cardiovascular Diseases "Dedinje", 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Viruses. 2025 Mar 15;17(3):427. doi: 10.3390/v17030427.
BACKGROUND/OBJECTIVES: Syncope is a common clinical occurrence, with neurally mediated and orthostatic types accounting for about 75% of cases. The exact pathophysiological mechanisms remain unclear, with recent evidence suggesting autonomic nervous system damage and a potential infectious etiology. This study aimed to examine the role of infection in the development of syncope and orthostatic hypotension (OH).
The cross-sectional study included 806 patients from the Neurocardiological Laboratory of the Institute for Cardiovascular Diseases "Dedinje". Patients were divided into three groups: unexplained recurrent syncope (n = 506), syncope with OH during the head-up tilt test (HUTT) (n = 235), and OH without a history of syncope (n = 62). All participants underwent the HUTT, and 495 underwent serological testing for various microorganisms. Data were analyzed using chi-squared tests and binary and multinomial logistic regression.
The HUTT was positive in 90.6% of patients with syncope and OH, compared with 61.6% with syncope alone ( < 0.001). Serological testing revealed that 57.85% of syncope patients, 62.9% of syncope with OH patients, and 78% of OH patients had positive IgM antibodies to at least one microorganism. Multivariate analysis indicated that IgM antibodies to Coxsackievirus and Epstein-Barr virus were significant predictors of OH.
This study demonstrated a potential association between infections and syncope/OH. Further investigation into the role of infectious agents in autonomic dysfunction is warranted to clarify the underlying mechanisms of syncope and OH.
背景/目的：晕厥是一种常见的临床现象，神经介导性和体位性晕厥约占病例的75%。确切的病理生理机制尚不清楚，最近有证据表明存在自主神经系统损伤和潜在的感染病因。本研究旨在探讨感染在晕厥和体位性低血压（OH）发生发展中的作用。
这项横断面研究纳入了来自“德丁耶”心血管疾病研究所神经心脏病学实验室的806例患者。患者分为三组：不明原因的反复晕厥（n = 506）、直立倾斜试验（HUTT）期间伴有OH的晕厥（n = 235）以及无晕厥病史的OH（n = 62）。所有参与者均接受了HUTT，495例接受了针对各种微生物的血清学检测。数据采用卡方检验以及二元和多项逻辑回归进行分析。
伴有OH的晕厥患者中90.6%的HUTT结果为阳性，而单纯晕厥患者中这一比例为61.6%（P < 0.001）。血清学检测显示，57.85%的晕厥患者、62.9%的伴有OH的晕厥患者以及78%的OH患者针对至少一种微生物的IgM抗体呈阳性。多变量分析表明，柯萨奇病毒和爱泼斯坦-巴尔病毒的IgM抗体是OH的显著预测指标。
本研究表明感染与晕厥/OH之间存在潜在关联。有必要进一步研究感染因子在自主神经功能障碍中的作用，以阐明晕厥和OH的潜在机制。
