体位性心动过速综合征患儿直立倾斜试验中血浆中介素的变化及意义  

Changes of plasma intermedin during head-up tilt test in children with postural tachycardia syndrome and its significance

作　　者：李红霞[1] 廖莹[1] 憨贞慧 王瑜丽[1] 刘平[1] 张清友[1] 蔺婧[1] 唐朝枢[3] 金红芳[1] 杜军保[1] 

机构地区：[1]北京大学第一医院儿科,100034 [2]河南省开封市儿童医院 [3]北京大学医学部生理学与病理生理学系

出　　处：《中华儿科杂志》2015年第5期375-378,共4页Chinese Journal of Pediatrics

基　　金：国家自然科学基金（81121061）;国家“十二五”支撑计划项目（2012BA103803）

摘　　要：目的 探讨体位性心动过速综合征（POTS）患儿在直立倾斜试验（HUTT）中血浆中介素含量的变化.方法 选取2013年11月至2014年6月北京大学第一医院收治的29例POTS患儿为研究对象,男14例,女15例,平均年龄（12.4±3.1）岁;经体格检查和HUTT筛查的健康儿童32例为对照组,男17例,女15例,平均年龄（11.6±2.2）岁.采用无创连续血压监测仪连续实时监测心率及血压,并进行心电图检测,分析比较POTS组患儿和对照组儿童平卧位收缩压、平卧位舒张压、平卧位平均动脉压（MAP）、△MAP（直立位与平卧位MAP差）、平卧位心率及△HR（直立位与平卧位心率差）.采用夹心免疫发光法测定血浆中介素含量,分别比较POTS组与对照组平卧位血浆中介素的含量及POTS组患儿平卧状态下与HUTT阳性反应时血浆中介素的含量.结果 POTS组患儿和对照组儿童相比,年龄、身高、体重、平卧位收缩压、平卧位舒张压、平卧位MAP、△MAP、平卧位心率差异均无统计学意义（P＞0.05）.POTS组△HR明显高于对照组,差异有统计学意义[（48±10）比（22±7）次/min,t=9.797,P＜0.05].平卧状态下,POTS组患儿血浆中介素的含量明显低于对照组儿童[（497±61） ×10-6比（529±58） ×10-6 mg/L,t =2.117,P＜0.05].HUTT阳性反应时,血浆中介素含量明显高于平卧位[（537±57）×10-6比（497±61）× 10-6mg/L,t=-2.464,P＜0.05].POTS组患儿HUTT阳性反应时与平卧状态下血浆中介素含量的差值与△HR成正相关（r=0.435,P＜0.05）.结论 POTS患儿直立倾斜体位时心率增加值与其血浆中介素含量升高幅度有关,中介素可能参与POTS的发病过程.Objective To explore possible mechanisms of postural tachycardia syndrome （POTS） by comparing plasma intermedin （IMD） during head-up tilt test （HUTT） in children with POTS.Method The study subjects were divided into two groups：POTS group and control group.The POTS group consisted of twenty-nine children （male 14,female 15） with POTS,the mean age （12.4 ±3.1） years old,admitted into Peking University First Hospital from November 2013 to June 2014.The control group consisted of 32 healthy children （male 17,female 15）.Their mean age was （11.6 ± 2.2） years old,who were confirmed as healthy by physical examination and HUTT.Finapres Medical System was used to continuously monitor heart rate and blood pressure during HUTT,and electrocadiogram was performed.Supine systolic and diastolic blood pressure,mean arterial pressure （MAP）,△MAP （standing mean arterial pressure-supine MAP）,supine heart rate and △HR （standing HR-supine HR） were compared between POTS group and control group.Sandwich immunoluminescence assay was used to test plasma IMD.The plasma IMD level was compared in supine between POTS and control group.The plasma IMD level in supine was compared with HUTT in POTS group.Result No significant differences were found in age,height,weight,supine systolic and diastolic blood pressure,MAP,△MAP and supine heart rate between POTS group and control group （P 〉0.05）.△HR in POTS group was significantly higher than that of control group （（48 ± 10） vs.（22 ± 7） beats/min,t =9.797,P 〈 0.05）.The plasma IMD level in POTS group was lower than that of control group in supine position （（497 ±61） × 10-6 vs.（529 ±58） × 10-6 mg/L,t =2.117,P 〈0.05）.But,it was higher during HUTT than supine IMD in POTS group （（537 ±57） × 10-6 vs.（497 ±61） × 10-6 mg/L,t =-2.464,P 〈 0.05）.The plasma delta IMD level （HUTT vs.supine） was positively correlated with delta HR in POTS group （r =0.435,P 〈 0.05）.Conclusion The excessively high hea

关 键 词：体位性心动过速综合征 心率 儿童 

分 类 号：R725.4[医药卫生—儿科]