维生素D缺乏与儿童血管迷走性晕厥症状严重程度的相关性  

Association of vitamin D deficiency with severity of symptoms in children with vasovagal syncope

作　　者：孔玉洁 边攀 杨轶男[1] 董童 牛少敏[1] 袁时健 董湘玉[1] Kong Yujie;Bian Pan;Yang Yinan;Dong Tong;Niu Shaomin;Yuan Shijian;Dong Xiangyu(Department of Pediatric Cardiology,Second Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院小儿心血管科,兰州730000

出　　处：《中华儿科杂志》2022年第6期557-561,共5页Chinese Journal of Pediatrics

基　　金：兰州市社会发展科技项目(2017-4-90)。

摘　　要：目的探讨血管迷走性晕厥(VVS)患儿维生素D缺乏与症状严重程度的相关性。方法前瞻性研究。选取2019年12月至2021年5月就诊于兰州大学第二医院小儿心血管科,VVS组为经直立倾斜试验确诊为VVS的122例患儿;对照组为同期就诊于兰州大学第二医院儿童保健科门诊进行体检、无不适症状的130名健康儿童。根据维生素D诊断标准把VVS组患儿分为维生素D非缺乏组、缺乏组、严重缺乏组。所有入组儿童进行常规评估,包括详细的病史调查、体格检查及血清25(OH)D水平测定。VVS组患儿进行直立不耐受(OI)症状评分,包括晕厥、头晕、恶心、心悸、头痛、震颤、胸闷、视物不清、大汗、注意力不集中10个症状。比较VVS组与对照组年龄、性别、体质指数、血压、血清25(OH)D水平的差异,比较VVS组患儿维生素D非缺乏组、缺乏组、严重缺乏组之间年龄、性别、体质指数、血压、血清25(OH)D水平和症状评分的差异。组间比较采用t检验、F检验、χ^(2)检验或秩和检验,VVS患儿血清25(OH)D水平与OI症状总评分相关性分析采用Pearson相关分析。结果VVS组患儿血清25(OH)D水平明显低于对照组[(31±11)比(46±10)nmol/L,t=10.89,P<0.001]。VVS组25(OH)D缺乏率为73.0%(89/122),对照组25(OH)D缺乏率为24.6%(32/130),差异有统计学意义(χ^(2)=58.91,P<0.001)。VVS患儿维生素D严重缺乏组、缺乏组、非缺乏组血清25(OH)D水平分别为(9.8±0.4)、(26.6±6.5)和(45.8±5.9)nmol/L,组间比较差异有统计学意义(F=142.77,P<0.001)。VVS组患儿OI症状总评分在维生素D严重缺乏组、缺乏组及非缺乏组分别为(14±1)、(10±2)和(7±2)分,组间比较差异有统计学意义(F=44.97,P<0.001);其中晕厥、恶心、大汗、视物不清、头晕单项评分在维生素D严重缺乏组、缺乏组及非缺乏组差异均有统计学意义(H=9.01、7.52、12.11、7.07、9.54,均P<0.05)。Pearson相关分析显示,VVS患儿血清25(OH)D水平�Objective To investigate the correlation between vitamin D deficiency and the severity of symptoms in children with vasovagal syncope(VVS).Methods A prospective study was conducted.One hundred and twenty-two children diagnosed with VVS by head up tilt test in Department of Pediatric Cardiology and 130 healthy children without symptoms who underwent physical examination in the outpatient department of Child Healthcare Department of Second Hospital of Lanzhou University from December 2019 to May 2021 were selected and assigned to VVS group and control group,respectively.According to the diagnostic criteria of vitamin D deficiency,children in the VVS group were assigned to three subgroups:non-vitamin D deficiency,vitamin D deficiency,and severe vitamin D deficiency.All children underwent detailed history taking,physical examination,and level determination of serum 25(OH)D.Children in the VVS group were scored for orthostatic intolerance(OI)symptoms including 10 symptoms:syncope,dizziness,nausea,palpitation,headache,tremor,chest tightness,blurred vision,profuse perspiration,and attention deficit.The differences in the age,gender,body mass index,blood pressure,and serum 25(OH)D levels between VVS group and control group,and the differences regarding the age,gender,body mass index,blood pressure,serum 25(OH)D levels and symptom scores among the three VVS subgroups were compared.Comparisons were performed using independent sample t test,ANOVA analysis,Chi square test and rank sum test.Pearson correlation analysis was used to analyze the correlation between serum 25(OH)D levels and OI symptom scores in children with VVS.Results The serum 25(OH)D levels were significantly lower in the VVS group than those in the control group((31±11)vs.(46±10)nmol/L,t=10.89,P<0.001).Vitamin D deficiency was more frequent in the VVS group(73.0%(89/122)vs.24.6%(32/130),χ^(2)=58.91,P<0.001).There were significant differences among the severe vitamin D deficiency subgroup,vitamin D deficiency subgroup,and non-vitamin D deficiency subgroup

关 键 词：儿童 晕厥 血管迷走神经性 维生素D 

分 类 号：R725.4[医药卫生—儿科]