神经介导性晕厥发作的昼夜节律性研究  

Investigation of Circadian Rhythm for the Onset of Neurally Mediated Syncope in Relevant Patients

作　　者：廖冬磊 许毅[1] 吴礼嘉[1] 邹润梅[1] 罗雪梅[1] 李芳[1] 林萍[1] 王秀英[1] 谢振武[1] 王成[1] LIAO Dong-lei XU Yi WU Li-jia ZOU Run-rnei LUO Xue-mei LI Fang LIN Ping WANG Xiu-ying XIE Zhen-wu WANG Cheng.(Department of Pediatric Cardiology, Children＇s Medical Center, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China)

机构地区：[1]中南大学湘雅二医院儿童医学中心儿童心血管专科中南大学儿科学研究所,湖南省长沙市410011

出　　处：《中国循环杂志》2017年第2期165-169,共5页Chinese Circulation Journal

基　　金：湖南省发展改革委员会课题[湘财企指(2015)83号];湖南省自然科学基金(2016JJ2167)

摘　　要：目的:探讨神经介导性晕厥(NMS)发作的昼夜节律。方法:选择2013-12至2015-04期间在中南大学湘雅二医院晕厥专科门诊就诊或住院的NMS患者411例,其中青少年(<18岁)患者262例(63.7%),男性165例,女性246例,年龄3~68岁,平均年龄(20.95±15.20)岁。根据直立倾斜试验(HUTT)结果分为HUTT阳性组(n=281)和HUTT阴性组(n=130),详细询问患者或监护人既往晕厥发作的次数及每次发作的时间段(将1天分为4个时间段:上午06:00 am^12:00 am,下午12:00 am^18:00 pm,晚上18:00 pm^24:00 pm,夜间00:00 am^06:00 am)。结果:(1)一般资料:411例患者中晕厥发作总次数1 085次。HUTT阳性组晕厥总次数753次;HUTT阴性组晕厥总次数332次。HUTT阳性组和HUTT阴性组在性别上差异无统计学意义(P>0.05),HUTT阳性组年龄低于HUTT阴性组(P<0.05);(2)各时间段晕厥发作频次差异:全部患者的晕厥多发生在06:00 am^12:00 am,与其他时间段比较差异有统计学意义(P均<0.05)。HUTT阳性患者的晕厥发作主要在06:00 am^12:00 am,与其他时间段比较差异有统计学意义(P均<0.05);HUTT阴性组晕厥发作亦多见于06:00 am^12:00 am,但与其他各时间段比较差异无统计学意义(P>0.05);HUTT阳性组与HUTT阴性组的各时间段晕厥发作频次比较差异未见统计学意义(P>0.05);HUTT阳性组中,不同反应类型(直立性低血压和直立性高血压除外)患者在不同时间段晕厥发作次数差异未见统计学意义(P>0.05);(3)性别与年龄差异:6:00 am^12:00 am发生晕厥男性多于女性,18:00 pm^24:00 pm发生晕厥男性少于女性(P<0.05);年龄越小,6:00 am^12:00 am发生晕厥频次越多;年龄越大,00:00 am^06:00 am发生晕厥频次越多(P<0.001)。结论:晕厥发作存在昼夜节律。晕厥发作主要发生在6:00 am^12:00 am,晕厥在一天4个时间段内的发作频次存在性别和年龄差异。Objective： To explore the circadian rhythm for the onset of neurally mediated syncope （NMS） in relevant patients. Methods： A total of 411 NMS patients treated in our hospital from 2013-12 to 2015-04 were studied. There were 165 male and 246 female at the age from 3 to 68 （20.95±15.20） years including 262 （63.7%） youth （〈18 years）. According to head-up tilt test （HUTT）, the patients were divided into 2 groups： HUTT （＋） group,n=281 and HUTT （-） group,n=130. The onset frequency and time frame were collected from patients or guardians and a 24h day was divided into 4 periods as 06：00-12：00, 12：00 -18：00, 18：00-24：00 and 00：00-06：00 O＇clock. Results：①General data： there were 1085 syncope onsets occurred in 411 patients including 753 times in HUTT （＋） group and 332 in HUTT （-） group. The onset had similar gender ratio between 2 groups,P〉0.05, the patients＇ age in HUTT （＋） group was younger than HUTT （-） group,P〈0.05.②Differences of onset frequency at various periods of the day： in all patients, the syncope onset was mostly occurred at 06：00-12：00 period, P〈0.05. Compared with other periods, the onset in HUTT （＋） groupmainly happened at 06：00-12：00 period,P〈0.05, HUTT （-） group had the similar trend whileP〉0.05; the onset frequency at various period was similar between 2 groups,P〉0.05. In HUTT （＋） group, different HUTT responses （except orthostatic hypotension and orthostatic hypertension） had similar onset frequency at various period,P〉0.05.③Differences in gender and age： at 06：00-12：00 period, the onset in male was more than female and at 18：00-24：00 period, the onset in male was less than female,P〈0.05. The younger the patients were, the more onsets were at 06：00-12：00 period, the older the patients were, the more onsets were at 00：00-06：00 period,P〈0.001. Conclusion： The onset of syncope had circadian rhythm and it was mainly occurred at 06：00-12：00 period o

关 键 词：晕厥 昼夜节律 性别因素 年龄因素 

分 类 号：R54[医药卫生—心血管疾病]