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目的:探讨神经介导性晕厥(NMS)发作的昼夜节律。方法:选择2013-12至2015-04期间在中南大学湘雅二医院晕厥专科门诊就诊或住院的NMS患者411例,其中青少年(<18岁)患者262例(63.7%),男性165例,女性246例,年龄3~68岁,平均年龄(20.95±15.20)岁。根据直立倾斜试验(HUTT)结果分为HUTT阳性组(n=281)和HUTT阴性组(n=130),详细询问患者或监护人既往晕厥发作的次数及每次发作的时间段(将1天分为4个时间段:上午06:00 am~12:00 am,下午12:00 am~18:00 pm,晚上18:00 pm~24:00 pm,夜间00:00 am~06:00 am)。结果:(1)一般资料:411例患者中晕厥发作总次数1 085次。HUTT阳性组晕厥总次数753次;HUTT阴性组晕厥总次数332次。HUTT阳性组和HUTT阴性组在性别上差异无统计学意义(P>0.05),HUTT阳性组年龄低于HUTT阴性组(P<0.05);(2)各时间段晕厥发作频次差异:全部患者的晕厥多发生在06:00 am~12:00 am,与其他时间段比较差异有统计学意义(P均<0.05)。HUTT阳性患者的晕厥发作主要在06:00 am~12:00 am,与其他时间段比较差异有统计学意义(P均<0.05);HUTT阴性组晕厥发作亦多见于06:00 am~12:00 am,但与其他各时间段比较差异无统计学意义(P>0.05);HUTT阳性组与HUTT阴性组的各时间段晕厥发作频次比较差异未见统计学意义(P>0.05);HUTT阳性组中,不同反应类型(直立性低血压和直立性高血压除外)患者在不同时间段晕厥发作次数差异未见统计学意义(P>0.05);(3)性别与年龄差异:6:00 am~12:00 am发生晕厥男性多于女性,18:00 pm~24:00 pm发生晕厥男性少于女性(P<0.05);年龄越小,6:00 am~12:00 am发生晕厥频次越多;年龄越大,00:00 am~06:00 am发生晕厥频次越多(P<0.001)。结论:晕厥发作存在昼夜节律。晕厥发作主要发生在6:00 am~12:00 am,晕厥在一天4个时间段内的发作频次存在性别和年龄差异。
Objective: To investigate the circadian rhythm of neurological mediated syncope (NMS). METHODS: A total of 411 NMS patients were enrolled in the Syncope Specialist Clinic of Xiangya Second Hospital of Central South University from December 2013 to April 2015, of which 262 (63.7%) were adolescents (<18 years), 165 males 246 cases, aged 3 to 68 years, mean age (20.95 ± 15.20) years. Patients were divided into HUTT-positive group (n = 281) and HUTT-negative group (n = 130) according to the results of Hypertrophic Lean Test (HUTT). The patients were asked in detail about the number of past episodes of syncope and the duration of each episode For 4 time periods: 06:00 am ~ 12: 00 am, 12:00 am ~ 18:00 pm, 18:00 pm ~ 24:00 pm, 00:00 am ~ 06:00 pm at night) . Results: (1) General Information: The total number of syncope episodes in 411 patients was 1 085 times. The total number of syncope in HUTT positive group was 753 times; the total number of syncope in HUTT negative group was 332 times. HUTT positive group and HUTT negative group had no significant difference in gender (P> 0.05), HUTT positive group was lower than HUTT negative group (P <0.05); (2) Frequency of syncope seizure in each time period: Syncope occurred in more than 06:00 am ~ 12: 00 am, with other time difference was statistically significant (P all <0.05). The incidence of syncope in patients with HUTT positive was mainly between 06:00 am and 12:00 am (P <0.05), and the incidence of syncope in patients with HUTT negative was also higher than that between 06:00 am and 12: 00 am (P> 0.05). There was no significant difference in frequency of syncope in each time period between HUTT positive group and HUTT negative group (P> 0.05). HUTT positive (P> 0.05). (3) The difference of sex and age: 6: 00 am (P> 0.05). There was no significant difference in the number of syncope episodes between different types of patients (except orthostatic hypotension and orthostatic hypertension) ~ 12: 00 am, there were more men than women with syncope. There were fewer syncope men than women at 18: 00 pm ~ 24: 00 pm (P <0.05). The younger the age, the frequency of syncope was between 6: 00 am ~ 12: 00 am The older the frequency of syncope was (00.00 am ~ 06.00 am) (P <0.001). Conclusion: There are circadian rhythms in syncope. Syncope attack occurs mainly in 6:00 am ~ 12: 00 am, syncope in the four time periods of the frequency of seizures there is gender and age differences.