| Objective:1 We divided all of the research cases who were from The SecondHospital of Hebei Medical University pediatric cardiovascular outpatient department during August 2007 to December 2015 going to hospital because of syncope,dizziness,headache,chest tightness and long outlet which were considered as auto-nervous mediated syncope and chronic OI patients into two groups: the syncope group and the non-syncope group.All the patients were put on upright test or(and)head-up tilt test(including basic head-up tilt test and sublingual nitroglycerin potentiatedhead-up tilt test)to get a clear diagnosis.To specify the disease composition,disease proportion of the syncope group and the non-syncope group.2 To compare the difference of HUTT positive rate between the syncope group and the non-syncope group.3 To compare the difference between BHUT positive rate and SNHUT positive rate of the syncope group and the non-syncope group separately.4 To sum up upright test positive rate and the disease proportion of the patients who were test positive.To compare the difference of upright test positive rate between the syncope group and the non-syncope group.5 To analyze the influence of clinical characteristics on HUTT result of the syncope group and the non-syncope group separately.Methods: Retrospective study method was used in this study.All of the research cases were from The Second Hospital of Hebei Medical University pediatric cardiovascular outpatient department during August 2007 to December 2015.They went to hospital because of syncope,dizziness,headache,chest tightness and long outlet which were considered as auto-nervous mediated syncope and chronic orthostatic intolerance patients.All the patients were asked to give us a detailed account of the ill.We arranged comprehensive physical examination to all the patients and conducted the related auxiliary examination such as head MR or head CT,EEG or active EEG,echocardiography,ECG,Holter,blood biochemical examination,etc.We divided all the patients into two groups: the syncope group and the non-syncope group.The children in the syncope group complained about recurrent syncope(no less than 2 times)and were considered clinically as autonomic nervous mediated syncope,excepting for cardiac syncope,cerebral vascular syncope by the procedures for diagnosis of syncope in children prescribed in guidelines for the diagnosis of syncope in children.The children in the non-syncope group complained about dizziness,headache,chest tightness and long outlet.The symptom is notable in the morning.There always were long time standing,long time sitting,sultry environment and other incentives before the symptom occur.The non-syncope group children were considered as clinical OI,excepting nervous system disease(epilepsia,central nervous system infection,tumor,etc),cardiovascular system organic disease(cardiac origin syncope,myocarditis,arrhythmia,etc),metabolic disease(glucopenia,electrolyte disturbances,etc),respiratory disease(pneumonia,pleural disease,etc),digestive system disease,ENT disease and other systemic disease.At the beginning of the study,we took upright test to screen OI and some patients with POTS,OH and OHT can get a clear diagnosis at this stage.If the patient was upright test negative,the HUTT was used to assist the diagnosis.As the study going on,upright test was gradually abandoned because of its limitation and all the patients were put on HUTT to assist diagnosis instead.The HUTT includes BHUT and SNHUT.We analyzed the disease composition and its proportion of the syncope group and the non-syncope group,and compared the disease proportion of the two groups by chi-square test.The HUTT positive rates of the two groups were compared according to chi-square test.Chi-square test was also used to explore the difference between BHUT positive rate and SNHUT positive rate among the two groups separately.The influence of clinical characteristics on HUTT result of syncope group was analyzed by using binary Logistic regression analysis method.All statistical analyses were performed with software SPSS 21.0.Results: 1 The disease composition and the disease proportion of the syncope group and the non-syncope group 1.1 There were 112 patients in the syncope group,including 61 boys accounting for 54.5%,and 51 girls accounting for 45.5%,leaving the ratio of male to female 1.2.The mean age of the children in the syncope group was 11.37±1.90 years.18 patients were from 4 to 9 years old,accounting for 16.1%,87 patients were from 10 to 13 years old,accounting for 77.7% and 7 patients were no less than 14 years old,accounting for 6.3%.Among them,39 patients were diagnosed with VVS,accounting for 34.8%.Among the patients with VVS,21 patients were diagnosed with VVS-VI,18 patients were diagnosed with VVS-MI,0 patient was diagnosed with VVS-CI.38 patients were diagnosed with POTS,the proportion was 31.3%.3 patients were diagnosed with delayed POTS among the 38 patients.13 patients were diagnosed with OHT,the ratio was 11.6%.1 patient was diagnosed with OH,the ratio was 0.9% and 8 were diagnosed with OI,accounting for 7.1%.26 patients were not diagnosed with clear reason,accounting for 23.2%.1.2 In the non-syncope group,there were 109 patients,including 60 boys and 49 girls.Among them,22 were diagnosed with VVS,accounting for 29.36%.Among the patients with VVS,17 patients were diagnosed with VVS-VI,5 patients were diagnosed with VVS-MI,0 patient was diagnosed with VVS-CI.43 patients were diagnosed with POTS,the proportion was 39.45%.4 patients were diagnosed with delayed POTS among the 43 patients.8 patients were diagnosed with OHT,the ratio was 7.3%.4 patients were diagnosed with OH,the ratio was 3.7% and 9 were diagnosed with OI,accounting for 8.3%.39 patients were not diagnosed clearly,accounting for 27.5%.2 The comparison of the HUTT positive rate between the syncope group and the non-syncope group 2.1 104 patients were put on HUTT in the syncope group(the other 8 patients were put on upright test and obtained a clear diagnosis).Among them,63 patients were HUTT positive and 14 patients were HUTT negative.The HUTT positive rate was 60.6%.2.2 99 patients were put on HUTT in the non-syncope group(the other 10 patients were put on upright test and obtained a clear diagnosis).Among them,57 patients were HUTT positive and 42 patients were HUTT negative.The HUTT positive rate was 57.6%.2.3 Chi-square test was used to compare the difference between the syncope and non-syncope group,P>0.05.3 The comparison of BHUT and SNHUT positive rates in the syncope group and the non-syncope group 3.1 In the syncope group,104 patients were put on BHUT.Among them,67 were BHUT negative and 37 were BHUT positive,leaving BHUT positive rate 19.4%.36 patients were put on SNHUT.Among them,3 were SNHUT negative and 33 were SNHUT positive,leaving SNHUT positive rate 91.7%.A comparison of BHUT and SNHUT positive rates was made by using chi-square test,P<0.05.3.2 In the non-syncope group,99 patients were put on BHUT.Among them,62 were BHUT negative and 37 were BHUT positive,leaving BHUT positive rate 37.4%.37 were put on SNHUT.Among them,8 were SNHUT negative and 29 were SNHUT positive,leaving SNHUT positive rate 78.4%.The BHUT and SNHUT positive rates were compared by using chi-square test,P<0.05.4 The positive rate of the upright test and the proportion disease composition of the test positive patients.The comparison of the upright test positive rate between the syncope group and the non-syncope group.4.1 109 patients were put on upright test totally,among them,61 patients were test positive,39 patients were test negative and 9 patients were suspected positive,leaving upright test positive rate 56.0%.Among the 61 patients who were upright test positive,36 were diagnosed with OI;20 were diagnosed with POTS;3 were diagnosed with VVS;1 was diagnosed with OHT;1 was diagnosed with OH.4.2 55 patients were put on upright test in the syncope group.Among them,36 patients were test positive,14 patients were test negative and 5 patients were suspected positive,leaving upright test positive rate 65.5%.In the non-syncope group,54 patients were put on upright test.Among them,25 patients were test positive,25 patients were test negative and 4 patients were suspected positive,leaving upright test positive rate 46.3%.Chi-square test was used to compare the difference of the upright test positive rate between the syncope and non-syncope group,P<0.05.5 The analysis of the influence of clinical characteristics on HUTT result in the syncope group and the non-syncope group 5.1.1 The single factor analysis of the influence of clinical characteristics on HUTT outcome in the syncope group.The average age of HUTT positive group was higher than that of HUTT negative group,P <0.05;The proportion of having portent in the HUTT positive group was higher than that of the HUTT negative group,P <0.05;In the middle age group(10-13 years old),the HUTT positive rate was the highest,P <0.05.5.1.2 The multiple factors analysis of the influence of clinical characteristics on HUTT outcome in the syncope group.We analyzed the influence of clinical characteristics on the HUTT result by binary Logistic regression analysis,and then obtained the Logistic regression equation: LogitP=-3.893+0.956X2+2.345X5+1.034X10.In the equation,X2 was age,X5 was portent,X10 was ECG result in the HUTT.The chi-square test was carried out on the regression equation,?2?:12.378,P=0.006.5.2 The single factor analysis of the influence of clinical characteristics on HUTT outcome in the non-syncope group.Sex,age,first onset age,symptom and portent had no significant effect on the HUTT result.Conclusions:1 60.6% children with syncope and 57.6% children with dizziness,headache,chest tightness and long outlet can get a clear diagnosis by HUTT.Different hemodynamic types of autonomic nervous mediated syncope and chronic OI can be distinguished in the HUTT.On this basis,we can give corresponding treatment to the children.So HUTT is an essential diagnostic method for auto-nervous mediated syncope and OI.2 For patients suspected with autonomic nervous mediated syncope in the syncope group and chronic OI in the non-syncope group,the HUTT positive rate can be raised by carrying out SNHUT,thus assisting clinical diagnosis.3 Although 56.0% patients in the upright test can get a positive result,only 22.9% can be diagnosed clearly.There were 33.0% patients can not be identified with specific hemodynamic type and only be diagnosed with OI,who have to rely on HUTT to get diagnosed clearly.Besides,the patients in the syncope group are more likely to get a positive result in the upright test than the non-syncope group.4 In the syncope group,the patients who were elder,having portent and ECG positive in the HUTT are more likely to get HUTT positive.The most common portent symptoms are dizziness,chest tightness,palpitate and amaurosis.In the non-syncope group,there is no clinical characteristic having effect on the HUTT result. |
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