氯米帕明联合硝酸甘油激发直立倾斜试验对血管迷走性晕厥的诊断价值  

Diagnostic Value of Clomipramine Combined with Nitroglycerin Stimulated Head-up Tilt Testing for Vasovagal Syncope

作　　者：黄敏虎 沈松林[1] 蔡国才 唐波[1] HUANG Minhu;SHEN Songlin;CAI Guocai;TANG Bo(Mianyang Third People's Hospital,Mianyang 621000,Sichuan,China)

机构地区：[1]绵阳市第三人民医院,四川绵阳621000

出　　处：《中西医结合心脑血管病杂志》2023年第17期3252-3257,共6页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：绵阳市卫生健康委员会科研课题(No.201961)。

摘　　要：目的:探讨氯米帕明联合硝酸甘油激发直立倾斜试验(HUTT)对血管迷走性晕厥(VVS)的诊断价值。方法:选取2020年1月—2022年10月于绵阳市第三人民医院疑诊为VVS的病人120例,随机分为硝酸甘油激发HUTT组(试验1组)、氯米帕明激发HUTT组(试验2组)、氯米帕明联合硝酸甘油激发HUTT组(试验3组),每组40例。选取同期60名健康者,随机分为硝酸甘油激发HUTT组(对照1组)、氯米帕明激发HUTT组(对照2组)、氯米帕明联合硝酸甘油激发HUTT组(对照3组),每组20名。比较各组试验阳性率、阳性反应出现时间、并发症发生率、去甲肾上腺素(NE)、肾素活性(RA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、催乳素(PRL)、皮质醇(Cor)水平。结果:试验3组诊断的阳性率为87.50%(35/40),各组诊断的阳性率、阳性反应出现时间比较差异均无统计学意义(P>0.05)。120例疑诊为VVS病人的并发症发生率为40.00(48/120),高于健康者的20.00%(12/60),差异有统计学意义(χ^(2)=6.669,P<0.05);试验3组并发症发生率低于试验1组、试验2组,对照3组并发症发生率低于对照1组、对照2组。各组HUTT试验后NE、RA、AngⅡ、ALD和PRL、Cor水平均高于试验前,差异均有统计学意义(P<0.05);试验3组HUTT试验后NE、RA、AngⅡ、ALD、PRL、Cor水平高于试验1组、试验2组。受试者工作特征曲线(ROC)分析显示,硝酸甘油、氯米帕明激发HUTT诊断VVS的曲线下面积(AUC)分别为0.714,0.795,硝酸甘油联合氯米帕明激发HUTT诊断VVS的AUC为0.817,诊断准确性高于硝酸甘油、氯米帕明激发HUTT。结论:对于VVS病人氯米帕明联合硝酸甘油激发HUTT阳性的敏感性高,有利于临床医生提高VVS的诊断准确率。Objective:To investigate the diagnostic value of clomipramine combined with nitroglycerin stimulated head-up tilt testing(HUTT)in vasovagal syncope.Methods:A total of 120 patients suspected with vasovagal syncope in Mianyang Third People's Hospital from January 2020 to October 2022 were selected and randomly divided into nitroglycerin-induced HUTT group(test group 1,40 cases),clomipramine induced HUTT group(test group 2,40 cases),and clomipramine combined with nitroglycerin-induced HUTT group(test group 3,40 cases).During the same period,60 healthy subjects were selected and randomly divided into nitroglycerin-induced HUTT group(control group 1),clomipramine induced HUTT group(control group 2),and clomipramine induced HUTT group(control group 3),with 20 cases in each group.The test positivity rate,time to stimulation positive response,complication rate,noradrenaline(NE),renin activity(RA),angiotensinⅡ(AngⅡ),aldosterone(ALD),prolactin(PRL),and cortisol(Cor)levels were compared and analyzed among the three groups of subjects and the three groups of healthy subjects.Results:The positive rate of diagnosis in the clomipramine combined with nitroglycerin-induced HUTT group was 87.50%(35/40).There was no significant difference in the test positivity rate and time to stimulation positive response among the groups(P>0.05).The incidence of complications in 120 patients with suspected vasovagal syncope was 40.00%(48/120),which was higher than 20.00%(12/60)of healthy people,and the difference was statistically significant(χ^(2)=6.669,P<0.05).The incidence of complications in test group 3 was lower than that in test group 1 and test group 2,and the incidence of complications in control group 3 was lower than that in control group 1 and control group 2.The levels of NE,renin activity,AngⅡ,ALD,PRL,and Cor were higher after HUTT in all three groups of subjects and three healthy groups than that before the test,and the differences were statistically significant(P<0.05).The levels of NE,renin activity,AngⅡ,ALD,PRL,and Cor

关 键 词：血管迷走性晕厥 氯米帕明 硝酸甘油 直立倾斜试验 诊断价值 

分 类 号：R54[医药卫生—心血管疾病]