体重指数在鉴别儿童青少年体位性心动过速综合征和血管迷走性晕厥中的价值

doi:10.11852/zgetbjzz2020-0297

中国儿童保健杂志 ›› 2020, Vol. 28 ›› Issue (5): 506-510.DOI: 10.11852/zgetbjzz2020-0297

体重指数在鉴别儿童青少年体位性心动过速综合征和血管迷走性晕厥中的价值

荚婉茹^1*, 武敏^1*, 王嘉琪¹, 顾英², 张琦一¹, 沈杰³, 焦富勇⁴, 蔺婧¹

1 西安交通大学医学部公共卫生学院,陕西西安 710061;
2 西安交通大学第一附属医院儿科,陕西西安 710061;
3 浙江大学医学院附属儿童医院心血管内科、国家儿童健康与疾病临床医学研究中心,浙江杭州310051;
4 陕西省人民医院儿科,陕西西安 710068

收稿日期:2020-02-28 发布日期:2020-05-10 出版日期:2020-05-10
通讯作者: 焦富勇,E-mail:jiaofy@yeah.net;蔺婧,E-mail:linjing0127@xjtu.edu.cn
注:^*共同第一作者。
作者简介:荚婉茹(1996-),女 ,安徽人,在读硕士研究生,主要研究方向为流行病与卫生统计学;武敏(1996-),女,甘肃人,硕士研究生在读,主要研究方向为流行病与卫生统计学。
基金资助:
国家自然科学基金青年基金(81803263);浙江省卫生健康委省医药卫生科技计划项目(2020KY612)

Value of body mass index in differential diagnosis between postural tachycardia syndrome and vasovagal syncope in children and adolescents

JIA Wan-ru^1*, WU Min^1*, WANG Jia-qi¹, GU Ying², ZHANG Qi-yi¹, SHEN Jie³, JIAO Fu-yong⁴, LIN Jing¹

1 School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China;
2 Department of Pediatrics, the first Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China;
3 Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang 310051, China;
4 Department of Pediatrics, Shaanxi Provincial Peoples' Hospital, Xi'an, Shaanxi 710068, China

Received:2020-02-28 Online:2020-05-10 Published:2020-05-10
Contact: JIAO Fu-yong:jiaofy@yeah.net; LIN Jing, E-mail:linjing0127@xjtu.edu.cn

摘要/Abstract

摘要： 目的分析体重指数(BMI)在体位性心动过速综合征(POTS)患儿和血管迷走性晕厥(VVS)患儿中的分布差异,并探讨其在上述两种疾病鉴别中的应用价值。方法选取2015年6月至2019年12月在儿科门诊纳入以“不明原因晕厥”就诊的患儿260例,依据直立倾斜试验结果对患儿分组(POTS组110例,VVS组150例),并将同期行健康体检的82例儿童青少年作为对照组。所有受试者接受统一的身高及体重测量。计算BMI,对比分析各组间BMI分布差异,并采用受试者工作特征(ROC)曲线预测用BMI鉴别POTS和VVS患儿的诊断价值。结果对照组、POTS组和VVS组BMI均值分别为(20.51±2.91)kg/m²、(18.17±3.12)kg/m²和(19.91±3.69)kg/m²,其中POTS组患儿BMI较对照组和VVS组均显著降低(P＜0.001),但VVS组患儿BMI分布和对照组相比差异无统计学意义(P＝0.195)。三种VVS亚型间BMI分布差异亦有统计学意义(F＝3.229,P＝0.042)。利用ROC曲线分析BMI鉴别POTS患儿和VVS患儿的价值,结果显示ROC曲线下面积为0.644(95%CI:0.577~0.711,P＜0.001),当BMI＞19.30 kg/m²时,其预测某晕厥患儿是VVS的灵敏度和特异度分别为56.0%和71.8%。结论 POTS患儿较VVS患儿BMI明显降低,BMI在二者的鉴别诊断中具有一定的应用价值,可结合病史、体格检查和其他辅助检查作为临床初步诊断依据。

关键词: 体位性心动过速综合征, 血管迷走性晕厥, 体重指数, 儿童青少年

Abstract: Objective To analyze the statistical distribution of body mass index (BMI) in children with postural tachycardia syndrome (POTS) and children with vasovagal syncope (VVS), and to explore the application value of BMI in distinguishing the two diseases. Methods A total of 260 children and adolescents who complained of unexplained syncope were enrolled in this study from June 2015 to December 2019, and were divided into POTS group (n=110) and VVS group (n=150) after definite diagnosis by HUTT. Meanwhile, 82 subjects who took physical examination were selected as the control group. The data of BMI was collected after measuring the height and weight of all subjects in the same room, and its statistical difference among the three groups above was described. Then the receiver operating characteristic (ROC) curve was used to evaluate the value of BMI in distinguishing POTS and VVS. Results The average BMI of children in control group, POTS group and VVS group were (20. 51±2. 91) kg/m², (18. 17±3. 12)kg/m² and (19. 91±3. 69)kg/m², respectively. The BMI of children in POTS group was significantly lower than that in control group and VVS group (P＜0. 001). However, there was no statistically significant difference between VVS group and control group (P＝0. 195). As for the BMI difference among the three VVS subtypes, the statistically difference was significant(F＝3. 229,P＝0. 042). The area under the ROC curve of BMI was 0. 644 (95%CI: 0. 577-0. 711, P＜0. 001). Taking 19. 30 kg/m² as threshold BMI for VVS children and adolescents, the predicted sensitivity and specificity were 56. 0% and 71. 8%, respectively. Conclusions Children and adolescents with POTS have the significantly lower BMI than those with VVS. Thus, BMI is an acceptable auxiliary method to discriminate POTS and VVS combined with medical history, physical examination and other auxiliary examinations.

Key words: postural tachycardia syndrome, vasovagal syncope, body mass index, children and adolescents

中图分类号:

R725

荚婉茹, 武敏, 王嘉琪, 顾英, 张琦一, 沈杰, 焦富勇, 蔺婧. 体重指数在鉴别儿童青少年体位性心动过速综合征和血管迷走性晕厥中的价值[J]. 中国儿童保健杂志, 2020, 28(5): 506-510.

JIA Wan-ru, WU Min, WANG Jia-qi, GU Ying, ZHANG Qi-yi, SHEN Jie, JIAO Fu-yong, LIN Jing. Value of body mass index in differential diagnosis between postural tachycardia syndrome and vasovagal syncope in children and adolescents[J]. journal1, 2020, 28(5): 506-510.

参考文献

[1] Stewart JM,Boris JR,Chelimsky G,et al.Pediatric Disorders of Orthostatic Intolerance[J].Pediatrics,2018,141(1):e20171673.
[2] 田宏.基于生物标记分子的儿童血管迷走性晕厥与体位性心动过速综合征临床鉴别诊断[J].中国实用儿科杂志,2016,31(8):572-574.
[3] 赵娟,杜军保,金红芳.儿童体位性心动过速综合征的发病机制[J].实用儿科临床杂志,2012,27(7):540-542.
[4] Arnold AC,Ng J,Raj SR.Postural tachycardia syndrome–diagnosis,physiology,and prognosis[J].Auton Neurosci,2018,215:3-11.
[5] 梁敏,刘晓燕.儿童血管迷走神经性晕厥的发病机制及治疗[J].儿科药学杂志,2017,23(6):59-62.
[6] Tiago LLL,Barcellos SR,Moraes MA,et al.Low body mass index is associated with a positive response during a head-up tilt test[J].Pacing Clin Electrophysiol,2013,36(1):37-41.
[7] 王硕,谭传梅,秧茂盛,等.儿童青少年体位性心动过速综合征体质量指数变化[J].中国实用儿科杂志,2019,34(8):685-688.
[8] 中华医学会儿科学分会心血管学组,《中华儿科杂志》编辑委员会,北京医学会儿科学分会心血管学组,等.儿童晕厥诊断指南(2016年修订版)[J].中华儿科杂志,2016,54(4):246-250.
[9] 尚丽丽,彭宇阁,刘佳,李晓红,李艳.直立倾斜试验在儿童不明原因晕厥诊断中的应用[J].中国实用神经疾病杂志,2019,22(18):2026-2031.
[10] 中华人民共和国卫生部,中国国家标准化管理委员会.学生健康检查技术规范(GB/T 26343-2010)[S].北京:中国标准出版社出版,2011.
[11] 中华人民共和国国家卫生和计划生育委员会.学龄儿童青少年营养不良筛查(WS/T 456-2014)[S].2014.
[12] 中华人民共和国国家卫生和计划生育委员会.学龄儿童青少年超重与肥胖筛查(WS/T 586-2018)[S].2018.
[13] Li H,Wang Y,Liu P,et al.Body mass index(BMI)is associated with the therapeutic response to oral rehydration solution in children with postural tachycardia syndrome[J].Pediatr Cardiol,2016,37(7):1-6.
[14] 李章勇,刘晓燕.儿童体位性心动过速综合征发病机制及治疗[J].儿科药学杂志,2016,22(10):60-63.
[15] Mar PL,Raj SR.Postural orthostatic tachycardia syndrome:mechanisms and new therapies[J].Annu Rev Med,2020,71:235-248.
[16] 黎瑶,何爽,张蕾,等.自主神经介导性晕厥儿童在直立倾斜试验中阳性反应与并发症的早期发现和处理[J].临床儿科杂志,2019(11):837-842.
[17] Joo BE,Koo DL,et al.Seizure-like activities in patients with head-up tilt test-induced syncope[J].Medicine,2018,97(51):e13602.
[18] 李佳蔚,张清友,高洁,等.血清铁在鉴别儿童血管迷走性晕厥和体位性心动过速综合征中的意义[J].北京大学学报:医学版,2013,45(6):923-927.
[19] Zhang F,Li X,Stella C,et al.Plasma hydrogen sulfide in differential diagnosis between vasovagal syncope and postural orthostatic tachycardia syndrome in children[J].J Pediatr,2012,160(2):227-231.
[20] Tao C,Chen S,Li H,et al.Value of immediate heart rate alteration from supine to upright in differential diagnosis between vasovagal syncope and postural tachycardia syndrome in children[J].Front Pediatr,2018,6:343.
[21] Montgomery LD.Regional blood volume and peripheral blood flow in postural tachycardia syndrome[J].Am J Physiol Heart Circ Physiol,2004,287(3):1319-1327.
[22] Fu Q,et al.Cardiac origins of the postural orthostatic tachycardia syndrome[J].J the Am Coll Cardiol,2010,55(25):2858-2868.
[23] Kuo AY,et al.Differential autonomic nervous system response in obese and anorexic chickens(Gallus gallus)[J].Comp Biochem Physiol B Biochem Mol Biol,2006,144(3):359-364.

体重指数在鉴别儿童青少年体位性心动过速综合征和血管迷走性晕厥中的价值

Value of body mass index in differential diagnosis between postural tachycardia syndrome and vasovagal syncope in children and adolescents

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

[1]	吴巧玲, 徐健, 赵正言, 彭咏梅, 龚春丹. 超敏C反应蛋白与儿童青少年代谢综合征的相关性[J]. 中国儿童保健杂志, 2023, 31(4): 427-432.
[2]	张艳. 太原市8~11岁儿童体成分与血清尿酸的相关性分析[J]. 中国儿童保健杂志, 2022, 30(9): 1005-1009.
[3]	雷军, 周小燕, 何建勇, 金海菊, 刘丽芳, 叶飘. 丽水市城区学龄前儿童体重指数与体质健康的相关性研究[J]. 中国儿童保健杂志, 2022, 30(9): 1033-1036.
[4]	陶佳慧, 陈琳琳, 马钰, 丁琴琴, 王秋晶, 丁文清. 儿童青少年肌肉质量与心血管疾病危险因素的关系[J]. 中国儿童保健杂志, 2022, 30(7): 706-710.
[5]	刘宇, 杨新军. 异常出生体重与儿童青少年神经行为发育的研究进展[J]. 中国儿童保健杂志, 2022, 30(7): 759-763.
[6]	舒瑶, 张英波. 动作技能干预对智力障碍儿童青少年基本动作技能影响的系统综述[J]. 中国儿童保健杂志, 2022, 30(7): 770-774.
[7]	唐敏华, 赵根明, 姜永根, 朱虹, 李咏梅, 陈妮儿, 何玉萍, 姚春霞. 上海市松江区2 036名儿童青少年视力健康现状及其影响因素分析[J]. 中国儿童保健杂志, 2022, 30(3): 319-324.
[8]	周金玉, 白玲, 董洋洋, 蔡蓉蓉, 贾磊娜, 丁文清. 银川城区儿童青少年骨矿物质含量与肥胖相关关系的研究[J]. 中国儿童保健杂志, 2022, 30(1): 15-19.
[9]	余丽蓉, 杜香平, 吴限, 袁意, 杨玉, 余珍. 先天性肾上腺皮质增生症儿童及青少年的生存质量及其影响因素[J]. 中国儿童保健杂志, 2021, 29(8): 843-847.
[10]	周静, 曾令霞, 米白冰, 裴磊磊, 颜虹. 辅食添加对中国西部农村地区婴幼儿体重指数生长轨迹影响的出生队列研究[J]. 中国儿童保健杂志, 2021, 29(6): 594-599.
[11]	仲爱进, 刘惠林, 杨敏, 何梅香. 孕期超重、儿童期饮食行为与儿童期体重的相关性研究[J]. 中国儿童保健杂志, 2021, 29(6): 674-677.
[12]	刘科良, 伏学峰, 郝雪琦, 王耀峰, 孙林清. 西藏边坝县3~5岁儿童龋病与体重指数的关系研究[J]. 中国儿童保健杂志, 2021, 29(6): 682-684.
[13]	王椿淇, 刘磊, 刘洋, 许志勇, 王一诺, 庄绪秀, 闻德亮. 血清单胺氧化酶与儿童青少年肥胖之间的关系研究[J]. 中国儿童保健杂志, 2021, 29(2): 151-155.
[14]	李娟, 王海军, 陈巍. 运动改善大脑奖赏功能防治儿童青少年肥胖的研究进展[J]. 中国儿童保健杂志, 2021, 29(2): 165-168.
[15]	朱谦让, 戴月, 张坚, 张静娴, 谢玮. 儿童青少年膳食及血清锌状况与心血管疾病代谢危险因素的关系[J]. 中国儿童保健杂志, 2021, 29(12): 1304-1308.