学术论文

      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

      Predictive value of upright blood pressure change for long-term prognosis of children with postural tachycardia syndrome treated with midodrine hydrochloride

      摘要:
      目的 探讨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(POTS)远期疗效的预测价值.方法 本研究共纳入于2005至201 1年在北京大学第一医院儿科就诊并确诊为POTS的患儿90例,男41例,女49例,平均年龄为(11.8±2.7)岁.所有患儿均应用盐酸米多君治疗.依据初诊时患儿直立后血压变化值分为两组,即有效组(55例)和无效组(35例).随访时间53~ 130个月,研究不同随访时间两组患儿的症状评分,并通过Kaplan-Meier曲线对两组患儿长期无症状百分比进行比较.结果 两组患儿的收缩压变化值及舒张压变化值具有统计学差异,有效组明显低于无效组[0(-6,0)mmHg(1 mmHg =0.133 kPa)比9(6,11) mmHg,Z=-8.303,P<0.01;0(0,5)mmHg比11(10,16) mmHg,Z=-7.058,P<0.01];治疗前两组的症状评分差异无统计学意义[(4.8±0.9)分比(5.0±0.8)分,t=-0.53,P=0.595];治疗后有效组的症状评分低于无效组[(1.3±0.9)分比(4.7±0.9)分,t=-15.60,P<0.01].随访终点时两组患儿无症状百分比的比较:有效组的无症状百分比明显高于无效组[48/55 (87.3%)比23/35 (65.7%),x2=5.969,P<0.05];Kaplan-Meier曲线分析结果表明,有效组患儿的无症状百分比高于无效组(x2=15.30,P<0.01).结论 直立后血压变化对于预测盐酸米多君治疗POTS患儿的长期疗效具有良好的价值.
      Abstract:
      Objective To explore the predictive value of upright blood pressure change for longterm prognosis of children with postural tachycardia syndrome (POTS) treated with midodrine hydrochloride.Method A total of 90 children (male 41,female 49) were enrolled in this study.Their mean age was (11.8 ± 2.7) years.They were diagnosed as POTS in Peking University First Hospital from 2005 to 2011.According to the upright change of blood pressure at the first visit,they were divided into two groups,effective group (n =55) and ineffective group (n =35).The follow-up time was 53-130 months.The orthostatic intolerance symptom score and symptom free survival rate were compared between the two groups.Result The change of systolic blood pressure and of diastolic blood pressure was lower in effective group than those in ineffective group (0(-6,0) mmHg (1 mmHg =0.133 kPa) vs.9(6,11) mmHg,Z =-8.303,P<0.01;0(0,5) mmHgvs.11(10,16) mmHg,Z=-7.058,P<0.01).Two groups had no significant difference in symptom scores before treatment((4.8 ±0.9) points vs.(5.0 ±0.8) points,t =-0.53,P =0.595),while symptom scores were lower in effective group than that in ineffective group ((1.3 ±0.9) points vs.(4.7 ±0.9) points,t =-15.60,P <0.01).The symptom free survival rate was higher in effective group than that in ineffective group (48/55 (87.3%) vs.23/35 (65.7%),x2 =5.969,P <0.01).Conclusion The upright change of blood pressure has a good predictive value on the long-term survival of POTS children treated with midodrine hydrochloride.
      Author: Li Hongxia Deng Wenjun Zhang Chunyu Jin Hongfang Du Junbao
      作者单位: 100034,北京大学第一医院儿科
      刊 名: 中华儿科杂志 ISTICPKU
      年,卷(期): 2016, 54(7)
      在线出版日期: 2016年7月29日