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目的比较舌下含服硝酸甘油和静脉注射异丙肾上腺素直立倾斜试验(head-uptilttest,HUTT)诊断血管迷走性晕厥(vasovagal syncope,VVS)的价值。方法 30例无晕厥史的健康人与84例不明原因晕厥患者在1周内先后进行基础结合硝酸甘油诱发和基础结合异丙肾上腺素诱发的HUTT,比较两种方法对VVS的诊断价值及差异。结果硝酸甘油诱发的HUTT与异丙肾上腺素诱发的HUTT诊断VVS的敏感性[61.9%(52/84)vs.58.3%(49/84),P=0.750]、特异性[96.7%(29/30)vs.100%(30/30),P=0.992]、阳性预测值[98.1%(52/53)vs.100%(49/49),P=0.974]、阴性预测值[47.5%(32/61)vs.47.3%(32/61),P=0.881]比较,差异无统计学意义。两种方法一致性检验值KAPPA为0.932,但硝酸甘油诱发阳性反应时间[(8.5±3.2)minvs.(25.4±9.9)min,P<0.05]及总试验时间[(38.5±3.2)minvs.(55.4±9.9)min,P<0.05]少于异丙肾上腺素,差异有统计学意义。结论硝酸甘油激发的HUTT诊断VVS安全有效,简单易行,值得推广使用。
Objective To compare the value of sublingual nitroglycerin and intravenous injection of isoprenaline in the diagnosis of vasovagal syncope (VVS) in patients with head-uptilttest (HUTT). Methods Thirty healthy people without history of syncope and 84 patients with unexplained syncope were treated with nitroglycerin and basic isoproterenol-induced HUTT within one week. The diagnostic value and difference of the two methods in VVS were compared. Results The sensitivity of HUTT induced by nitroglycerin and isoprenaline-induced HUTT was 61.9% (52/84) vs 58.3% (49/84), P = 0.750 and 96.7% 30) vs 100% (30/30), P = 0.992], positive predictive value [98.1% (52/53) vs.100% (49/49), P = 0.974], negative predictive value [47.5% 32/61) vs.47.3% (32/61), P = 0.881], the difference was not statistically significant. The KAPPA of the two methods was 0.932, but the positive reaction time of nitroglycerin induction was [(8.5 ± 3.2) min vs (25.4 ± 9.9) min, P <0.05] and the total test time was (38.5 ± 3.2) min vs 55.4 ± 9.9) min, P <0.05] less than isoproterenol, the difference was statistically significant. Conclusion Nitroglycerin-induced HUTT is safe, effective and simple to diagnose.