作者：王慧芳，黄织春

单位：

010000内蒙古自治区呼和浩特市，内蒙古医科大学附属医院心血管内科

单位（英文）：

Department of Cardiology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, China

关键词：

晕厥，血管迷走神经性；直立倾斜试验；心室复极化

关键词（英文）：

Syncope, vasovagal; Head-up tilt test; Ventricular repolarization

中图分类号：

R 544.2

DOI：

10.12114/j.issn.1008-5971.2023.00.207

基金项目：

内蒙古自治区科技计划项目（201802112）

摘要：

目的　探索直立倾斜试验（HUTT）期间心室复极化指标与血管迷走性晕厥（VVS）的关系。方法　选取2021年1月至2022年10月就诊于内蒙古医科大学附属医院并行HUTT的疑似VVS患者79例为研究对象。收集患者一般资料，记录患者入院时（T0）及HUTT预倾斜阶段（患者平躺时，T1）、后倾阶段（患者出现阳性结果时，T2）、试验结束时（患者回到平躺位置后，T3）心室复极化指标〔包括RR间期、QT间期、QTc间期、QTp间期、Tp-Te间期、Tp-Te/QT比值、Tp-Te/QTc比值、QT指数（QTI）、校正的QT间期指数（QTcI）〕。结果　79例患者中，HUTT阳性47例，将其作为VVS组；HUTT阴性32例，将其作为非VVS组。VVS组女性占比及恶心呕吐、黑蒙、出汗、面色苍白、乏力发生率高于非VVS组（P＜0.05）。VVS组T0时RR间期短于非VVS组，Tp-Te间期长于非VVS组，Tp-Te/QT比值、Tp-Te/QTc比值、QTI、QTcI高于非VVS组（P＜0.05）；VVS组T1时QTc间期、Tp-Te间期长于非VVS组，TpTe/QT比值、Tp-Te/QTc比值、QTI、QTcI高于非VVS组（P＜0.05）；VVS组T2时RR间期、QT间期、Tp-Te间期长于非VVS组，Tp-Te/QT比值、Tp-Te/QTc比值高于非VVS组（P＜0.05）；VVS组T3时RR间期、QT间期、QTc间期、QTp间期、Tp-Te间期长于非VVS组，Tp-Te/QTc比值、QTI高于非VVS组（P＜0.05）。非VVS组T2时RR间期、QT间期、QTp间期、Tp-Te间期短于T0、T1时，QTc间期长于T0、T1时，Tp-Te/QTc比值低于T0、T1时，QTI高于T0、T1时，QTcI高于T1时（P＜0.05）；非VVS组T3时RR间期、QT间期、QTp间期、Tp-Te间期短于T0、T1时，Tp-Te/QTc比值低于T0、T1时，QTcI高于T0、T1时，QTc间期长于T1时，RR间期长于T2时，QTc间期短于T2时，QTI、QTcI低于T2时（P＜0.05）；VVS组T2时QT间期短于T1时，QTp间期短于T0、T1时，Tp-Te间期长于T0、T1时，Tp-Te/QT比值、TpTe/QTc比值高于T0、T1时（P＜0.05）；VVS组T3时QT间期长于T0、T2时，QTp间期长于T0、T1、T2时，Tp-Te间期短于T2时，Tp-Te/QT比值、Tp-Te/QTc比值低于T1、T2时（P＜0.05）。结论　HUTT期间，VVS患者发病时RR间期、QT间期、Tp-Te间期延长，Tp-Te/QT比值、Tp-Te/QTc比值升高。

英文摘要：

Objective To explore the relationship between ventricular repolarization indexes and vasovagal syncope(VVS) during Head-Up Tilt Test (HUTT) . Methods A total of 79 suspected VVS patients who were admitted to the AffiliatedHospital of Inner Mongolia Medical University and underwent HUTT from January 2021 to October 2022 were selected as thestudy objects. General data of the patients were collected and ventricular repolarization indexes [including RR interval, QTinterval, QTc interval, QTp interval, Tp-Te interval, Tp-Te/QT ratio, Tp-Te/QTc ratio, QT index (QTI) , corrected QT intervalindex (QTcI) ] were recorded at admission (T0) , HUTT pre-tilt stage (when the patient was lying flat, T1) , retrotilt stage (whenthe patient had a positive result, T2) , and at the end of the trial (when the patient returned to the lying position, T3) . ResultsAmong the 79 patients, 47 cases were HUTT-positive and were included in the VVS group; 32 cases were HUTT-negative andwere included in the non-VVS group. The proportion of women and the incidence of nausea and vomiting, blackness, sweating,pale complexion, and fatigue in the VVS group were higher than those in the non-VVS group (P < 0.05) . At T0, the RR intervalin the VVS group was shorter than that in the non-VVS group, the Tp-Te interval was longer than that in the non-VVS group, andthe Tp-Te/QT ratio, Tp-Te/QTc ratio, QTI and QTcI were greater than those in the non-VVS group (P < 0.05) . At T1, the QTc interval and Tp-Te interval in the VVS group were longer than those in the non-VVS group, and the Tp-Te/QT ratio, Tp-Te/QTcratio, QTI and QTcI were greater than those in the non-VVS group (P < 0.05) . At T2, the RR interval, QT interval and Tp-Teinterval in the VVS group were longer than those in the non-VVS group, and the ratios of Tp-Te/QT and Tp-Te/QTc were greaterthan those in the non-VVS group (P < 0.05) . At T3, the RR interval, QT interval, QTc interval, QTp interval and Tp-Te intervalin the VVS group were longer than those in the non-VVS group, and the ratios of Tp-Te/QTc and QTI were greater than those inthe non-VVS group (P < 0.05) . In the non-VVS group, the RR interval, QT interval, QTp interval and Tp-Te interval at T2 wereshorter than those at T0 and T1, the QTc interval was longer than that at T0 and T1, the Tp-Te/QTc ratio was less than that at T0and T1, QTI was greater than that at T0 and T1, and the QTcI was greater than that at T1 (P < 0.05) . In the non-VVS group, RRinterval, QT interval, QTp interval, Tp-Te interval at T3 were shorter than those at T0 and T1, Tp-Te/QTc ratio was less than thatat T0 and T1, QTcI was greater than that at T0 and T1, QTc interval was longer than that at T1, RR interval was longer than thatat T2, QTc interval was shorter than that at T2, QTI and QTcI were less than those at T2 (P < 0.05) . In the VVS group, the QTinterval at T2 was shorter than that at T1, the QTp interval was shorter than that at T0 and T1, and the Tp-Te interval was longerthan that at T0 and T1, and the Tp-Te/QT ratio and the Tp-Te/QTc ratio were greater than those at T0 and T1 (P < 0.05) . In theVVS group, the QT interval at T3 was longer than that at T0 and T2, the QTp interval was longer than that at T0, T1 and T2, theTp-Te interval was shorter than that at T2, and the ratio of Tp-Te/QT and the ratio of Tp-Te/QTc were less than those at T1 andT2 (P < 0.05) . Conclusion During HUTT, the RR interval, QT interval and Tp-Te interval of VVS patients are prolonged, andthe ratio of Tp-Te/QT and Tp-Te/QTc are increased.

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