体位性心动过速综合征患儿唾液皮质醇水平与睡眠质量及临床症状严重程度的相关性分析

doi:10.11852/zgetbjzz2020-0299

中国儿童保健杂志 ›› 2020, Vol. 28 ›› Issue (4): 379-384.DOI: 10.11852/zgetbjzz2020-0299

体位性心动过速综合征患儿唾液皮质醇水平与睡眠质量及临床症状严重程度的相关性分析

张琦一^1,2*, 武敏^1*, 王嘉琪¹, 荚婉茹¹, 沈杰³, 张晓燕⁴, 蔺婧¹

1 西安交通大学医学部公共卫生学院儿少卫生与妇幼保健系,陕西西安 710061;
2 西北大学附属西安市第一医院门诊办,陕西西安,710002;
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:2020-04-10 出版日期:2020-04-10
通讯作者: 张晓燕,E-mail: 1103469732@qq.com;蔺婧,E-mail:linjing0127@xjtu.edu.cn
作者简介:张琦一(1989-),女 ,陕西人,在读硕士研究生,主要研究方向为流行病学; 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);浙江省卫生健康委员会科研项目(2020KY612)

Correlation between salivary cortisol levels with sleep quality and severity of clinical symptoms in children with postural tachycardia syndrome

ZHANG Qi-yi^{1, 2*}, WU Min^1*, WANG Jia-qi¹, JIA Wan-ru¹, SHEN Jie³, ZHANG Xiao-yan⁴, LIN Jing¹

1 Department of Maternal and Child Health, School of Public Health, Xi′an Jiaotong University, Xi′an, Shaanxi 710061, China;
2 Department of Office of Outpatient, the First Hospital of Xi′an City, Xi′an, Shaanxi 710002, China;
3 Department of Cardiology, the 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:2020-04-10 Published:2020-04-10
Contact: ZHANG Xiao-yan, E-mail:1103469732@qq.com; LIN Jing, E-mail: linjing0127@xjtu.edu.cn

摘要/Abstract

摘要： 目的评估体位性心动过速综合征(POTS)患儿睡眠质量和唾液皮质醇水平,分析唾液皮质醇水平与睡眠质量、临床症状严重程度的相关性。方法选择2018年5月-2019年5月在儿科确诊为POTS的患儿40例作为病例组,并纳入同期进行健康检查的儿童20例作为对照组。收集两组儿童6个时点(晨起清醒时、醒后30min、12:00、16:00、20:00以及晚间上床休息时)的唾液样品,利用酶联免疫吸附法测定唾液皮质醇浓度。通过匹兹堡睡眠质量指数(PSQI)量表及POTS症状评分表分别进行睡眠质量、POTS临床症状严重程度评估。结果对照组平卧位收缩压(t＝2.194)、直立位收缩压(t＝2.351)、直立位舒张压(t＝2.227)、平卧位稳定心率(t＝2.117)高于POTS组;直立位最大心率(t＝-3.88)、卧立位心率差值(t＝-7.86)低于POTS组,差异均有统计学意义(P＜0.05)。POTS组唾液皮质醇浓度在晨起清醒时、醒后30 min、12:00、16:00及20:00均高于对照组,差异有统计学意义(P＜0.05);POTS组患者睡眠质量(PSQI评分)较对照组明显较差[(7.2±3.0) vs.(1.35±1.39),t＝-10.370,P＜0.001],其中睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍和总分与对照组相比,差异均有统计学意义(P＜0.05);临床症状严重程度评分、PSQI评分与苏醒后唾液中皮质醇浓度呈正性相关(r＝0.62、0.60, P＜0.001);POTS症状评分与PSQI评分呈正相关(r=0.58, P＜0.001)。结论唾液皮质醇浓度与POTS患儿临床症状的严重程度、PSQI评分呈正相关。POTS患儿的唾液皮质醇浓度在一定程度上可以反映其睡眠质量和临床症状严重程度。

关键词: 体位性心动过速综合征, 唾液皮质醇, 睡眠质量指数, 临床症状严重程度

Abstract: Objective To evaluate the sleep quality and salivary cortisol level in children with postural tachycardia syndrome (POTS), and to analyze the correlation among salivary cortisol level, sleep quality and the severity of clinical symptoms. Methods This prospective study included 40 children with POTS (case group) from May 2018 to May 2019, and 20 healthy children who took health examination in the same period were selected as controls.Saliva samples were collected from two groups of children at six time points (awakening, 30 minutes after awakening, at 12:00 p.m., 4:00 p.m., and 8:00 p.m., and at bedtime), and the concentration of salivary cortisol was determined by enzyme-linked immunosorbent assay.The Pittsburgh Sleep Quality Index (PSQI) and POTS symptom scale were filled in to evaluate the sleep quality and the severity of clinical symptoms of POTS. Results The systolic blood pressure in supine position (t＝2.194), systolic blood pressure in upright position(t＝2.351), diastolic blood pressure in upright position (t＝2.227), stable heart rate in supine position(t＝2.117) in control group were significantly higher than those in POTS group, while the maximal heart rate in the upright position(t＝-3.88)and the difference in the resting and standing position (t＝-7.86) were significantly lower than those in POTS group(P＜0.05).The concentration of salivary cortisol in POTS group was significantly higher than that in the control group(P＜0.05) when waking up in the morning, 30 minutes after waking, at12:00, 4:00 pm and 8:00 pm.POTS group had poorer sleep quality (PSQI score) than control group[(7.2±3.0)vs.(1.35±1.39), t＝-10.370, P＜0.001], including sleep quality score, sleep time, sleep hours, sleep efficiency, sleep disorder, daytime dysfunction and overall comparison between groups.Symptom score and PSQI score were positively correlated with cortisol concentration in saliva after waking(r＝0.62, 0.60, P＜0.001).Moreover, symptom score and PSQI score were positively correlated(r=0.58,P＜0.001). Conclusionss Salivary cortisol concentration was positively correlated with the severity of clinical symptoms and PSQI score.To some extent, salivary cortisol concentration can reflect the sleep quality and clinical symptoms of children with POTS.

Key words: postural tachycardia syndrome, salivary cortisol, Pittsburgh Sleep Quality Index, severity of clinical symptoms

中图分类号:

R179

张琦一, 武敏, 王嘉琪, 荚婉茹, 沈杰, 张晓燕, 蔺婧. 体位性心动过速综合征患儿唾液皮质醇水平与睡眠质量及临床症状严重程度的相关性分析[J]. 中国儿童保健杂志, 2020, 28(4): 379-384.

ZHANG Qi-yi, WU Min, WANG Jia-qi, JIA Wan-ru, SHEN Jie, ZHANG Xiao-yan, LIN Jing. Correlation between salivary cortisol levels with sleep quality and severity of clinical symptoms in children with postural tachycardia syndrome[J]. journal1, 2020, 28(4): 379-384.

参考文献

[1] Goodman BP.Evaluation of postural tachycardia syndrome (POTS)[J].Auton Neurosci basic & clinical,2018,215(12):12-19.
[2] Wang C,Li Y,Liao Y,et al.2018 Chinese Pediatric Cardiology Society(CPCS)guideline for diagnosis and treatment of syncope in children and adolescents[J].Sci Bull,2018,63(23):1558-1564.
[3] Lin J,Han Z,Li X,et al.Risk factors for postural tachycardia syndrome in children and adolescents[J].PLoS One,2014,9(12):e113625.
[4] 陶春燕,杜军保.儿童体位性心动过速综合征个体化治疗研究进展[J].中国实用儿科杂志,2018,33(11):909-913,919.
[5] 李红霞,邓文军,张春雨,等.直立后血压变化对盐酸米多君治疗儿童体位性心动过速综合征远期疗效的预测价值[J].中华儿科杂志,2016,54(7):519-522.
[6] Song HT,Sun XY,Yang TS,et al.Effects of sleep deprivation on serum cortisol level and mental health in servicemen[J].Int J Psychophysiol ,2015,96(3):169-175.
[7] Forclaz MV,Moratto E,Pennisi A,et al.Salivary and serum cortisol levels in newborn infants[J].Arch Argent Pediatr,2017,115(3):262-266.
[8] 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.
[9] 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.2016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.
[10] Lin J,Han Z, Li H,et al.Plasma C-type natriuretic peptide as a predictor for therapeutic response to metoprolol in children with postural tachycardia syndrome[J].PLoS One, 2015,10(3):e0121913.
[11] 蔺婧,王瑜丽,张清友,等.儿童青少年晕厥疾病谱近30年变化及卫生经济学分析单中心报告[J].中国实用儿科杂志,2016,31(5):350-355.
[12] 刘贤臣,唐茂拜,胡蕾,等.匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志,1996,29(2):103-107.
[13] Lin J, Zhao HC, Shen J, et al.Salivary cortisol levels predict therapeutic response to a sleep-promoting method in children with postural tachycardia syndrome[J].Clinical Trial J Pediatr,2017,191(12):91-95.
[14] 郑娜,张印军,孙大庆.直立后血压变化对盐酸米多君治疗儿童体位性心动过速综合征远期疗效的预测价值[J].临床和实验医学杂志,2018,17(7):728-731.
[15] Mantella RC,Butters MA, Amico JA,et al.Salivary cortisol is associated with diagnosis and severity of latelife generalized anxiety disorder[J].Psychoneuroendocrinology,2008,33(6):773-781.
[16] Mar Philip L,Raj Satish R.Postural orthostatic tachycardia syndrome:mechanisms and new therapies[J].Annu Rev Med,2020,27(71):235-248.
[17] Bhake R C,Kluckner V,Stassen H,et al.Continuous free cortisol profiles-circadian rhythms in healthy men.[J].J Clin Endocr Metab,2019,104(12):5935-5947.
[18] Zipursky RT,Press MC,Srikanthan P,et al.Relation of stress hormones(urinary catecholamines/cortisol)to coronary artery calcium in men versus women(from the MultiEthnic Study of Atherosclerosis [MESA])[J].Am J Cardiol,2017,119(12):1963-1971.
[19] Zhang Q,Chen X,Li J,et al.Clinical features of hyperadrenergic postural tachycardia syndrome in children[J].Pediatr Int,2014,56(6):813-816.
[20] 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.
[21] Irwin M,Clark C,Kennedy B,et al.Nocturnal catecholamines and immune function in insomniacs,depressed patients,and control subjects[J].Brain Behav Immun,2003,17(5):365-372.
[22] Hirshkowitz M,Whiton K,Albert SM,et al.National Sleep Foundation′s sleep time duration recommendations: methodology and results summary[J].Sleep Health,2015,1(4):233-243.
[23] Abell JG, Shipley MJ,Ferrie JE,et al.Recurrent short sleep,chronic insomnia symptoms and salivary cortisol:a 10-year follow-up in the Whitehall II study[J].Psychoneuroendocrinology,2016,68(6):91-9.
[24] D′ Aurea C,Poyares D,Piovezan Ronaldo D,et al.Objective short sleep duration is associated with the activity of the hypothalamic-pituitary-adrenal axis in insomnia[J].Arquivos de neuro-psiquiatria,2015,73(6):516-519.
[25] Miglis MG,Barwick F. Sleep disorders-in patients-with postural tachycardia-syndrome:A review of the literature and guide for clinicians[J].Auton Neurosci,2018,215(12):62-69.
[26] 吕鑫,合浩,李晓霞,等.HPA轴与失眠障碍的相关性研究进展[J].世界睡眠医学杂志,2019,6(7):1009-1012.
[27] Schüssler P,Kluge M,Gamringer W,et al.Corticotropin-releasing hormone induces depression-like changes of sleep electroencephalogram in healthy women[J].Psychoneuroendocrinology,2016,74(7):302-307.
[28] 中国青少年儿童睡眠健康白皮书2019年[C].艾瑞咨询系列研究报告:上海艾瑞市场咨询有限公司,2019,4:185-235.

体位性心动过速综合征患儿唾液皮质醇水平与睡眠质量及临床症状严重程度的相关性分析

Correlation between salivary cortisol levels with sleep quality and severity of clinical symptoms in children with postural tachycardia syndrome

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