直立不耐受症状评分及儿茶酚胺与血管迷走性晕厥患儿情绪障碍的相关性

doi:10.6040/j.issn.1671-7554.0.2025.0044

摘要/Abstract

摘要： 目的探讨直立不耐受症状评分及24 h尿儿茶酚胺在血管迷走性晕厥(vasovagal syncope, VVS)患儿焦虑及抑郁性情绪障碍评估中的临床意义。方法回顾性分析2018年6月至2021年12月山东大学齐鲁医院儿童心血管病房诊治的53例VVS患儿临床资料,根据心理量表评分分为焦虑组(n=29)、非焦虑组(n=24)、抑郁组(n=13)和非抑郁组(n=40)。所有患儿在入院后进行直立不耐受症状评分,儿童焦虑性情绪障碍筛查量表(screen for child anxiety related emotional disorders, SCARED)评估患儿焦虑性情绪障碍程度,儿童抑郁量表(child depression inventory, CDI)评估患儿抑郁性情绪障碍程度,采用液相二级质谱法检测患儿24 h尿儿茶酚胺水平。采用国内已发表相同量表的学龄期儿童作为常模组。组间比较采用t检验、Mann-Whitney U检验或χ²检验,相关性分析采用Pearson或Spearman相关,采用ROC曲线分析直立不耐受症状评分的预测价值。结果 (1)53例VVS患儿SCARED评分(26.7±15.5)分,高于常模组(t=5.73,P<0.001);焦虑障碍检出率54.7%,高于常模组(χ²=21.12,P<0.001);CDI评分(14.3±8.8)分,高于常模组(t=2.21,P=0.032);抑郁障碍检出率24.5%,高于常模组(χ²=3.95,P=0.047);(2)非焦虑组直立不耐受症状评分低于焦虑组(Z=5.25,P<0.001);53例患儿SCARED评分与直立不耐受症状评分呈正相关(r_s=0.76,P<0.001),与24 h尿去甲肾上腺素水平无相关性(r=-0.16,P=0.254),与24 h尿肾上腺素、多巴胺水平无相关性(r_s=-0.16,-0.21;P=0.245,0.136);(3)非抑郁组患儿直立不耐受症状评分与抑郁组差异无统计学意义(Z=1.68,P=0.093);53例VVS患儿CDI评分与直立不耐受症状评分呈正相关(r_s=0.41,P=0.002),与24 h尿去甲肾上腺素水平无相关性(r=-0.07,P=0.616);与24 h尿肾上腺素和多巴胺水平无相关性(r_s=-0.09,-0.10;P=0.502,0.475);(4)VVS患儿直立不耐受症状评分为8.5分时,其预测VVS患儿存在焦虑性情绪障碍的灵敏度为75.9%,特异度为95.8%,其预测VVS患儿存在抑郁性情绪障碍的灵敏度69.2%,特异度为65.0%。结论 VVS患儿SCARED及CDI评分与直立不耐受症状评分呈正相关,与24 h尿儿茶酚胺水平呈无相关性;直立不耐受症状评分对VVS患儿情绪障碍有预测价值。

关键词: 情绪障碍, 晕厥, 直立不耐受, 儿茶酚胺, 儿童

Abstract: Objective To explore the clinical significance of orthostatic intolerance(OI)symptom scores and 24 h urinary catecholamines in the assessment of anxiety and depressive disorders in children with vasovagal syncope(VVS). Methods This was a retrospective analysis. The medical records of 53 children with VVS admitted to the Department of Pediatrics, Qilu Hospital of Shandong University from June 2018 to December 2021 were collected. They were divided into anxious group(29 cases), non-anxious group(24 cases), depressed group(13 cases), and non-depressed group(40 cases)according to the scores of psychological scale. All children were assessed using the OI symptom score, screen for child anxiety related emotional disorders(SCARED), and child depression inventory(CDI)scales. The childrens 24 h urinary catecholamine levels were analyzed by liquid chromatography-tandem mass spectrometry. Normative controls were derived from nationally published studies of school-aged children normal model group assessed with the same scales. t-test, Mann-Whitney U-test, and χ² test were used to compare the data between groups. The Pearson or Spearman correlation method was used for correlation analysis, and the predictive value of the OI symptom scores was analyzed using the ROC curve. Results (1)The mean SCARED score of 53 children with VVS was 26.7±15.5, higher than that of the normal model group(t=5.73, P<0.001); the detection rate of anxiety disorder was 54.7%, which was also higher than that of the normal model group(χ²=21.12, P<0.001). The mean CDI score of 53 children was 14.3±8.8, higher than that of the normal model group(t=2.21, P=0.032); the detection rate of depressive disorder was 24.5%, higher than that of the normal model group(χ²=3.95, P=0.047). (2)The non-anxious group had lower OI symptom scores than the anxious group(Z=5.25, P<0.001); 53 children had a positive correlation between SCARED scores and OI symptom scores(r_s=0.76, P<0.001); there was no correlation with 24 h urinary nonepinephrine levels(r=-0.16, P=0.254), and no correlation with 24 h urinary adrenaline or dopamine levels(r_s=-0.16, -0.21; P=0.245, 0.136). (3)There was no significant difference in OI symptom scores between non-depressive and depressive children(Z=1.68, P=0.093); there was a positive correlation between CDI scores and OI symptom scores in 53 children(r_s=0.41, P=0.002), and there was no correlation with 24 h urinary nonepinephrine levels(r=-0.07, P=0.616)and no correlation with 24 h urinary adrenaline and dopamine levels(r_s=-0.09, -0.10; P=0.502, 0.475). (4)When the OI symptom score in children with VVS was 8.5, its sensitivity for predicting the presence of anxiety disorders in children with VVS was 75.9% and its specificity was 95.8%, while those for depressive disorders were 69.2% and 65.0%, respectively. Conclusion SCARED and CDI scores of children with VVS are positively correlated with OI symptom scores, but not with 24 h urinary catecholamine levels; OI symptom scores have predictive value for emotional disorders in children with VVS.

Key words: Emotional disorder, Syncope, Orthostatic intolerance, Catecholamines, Children

中图分类号:

R725.4

李玲,闫宇晗,孔清玉,王敏敏,赵海招,赵翠芬. 直立不耐受症状评分及儿茶酚胺与血管迷走性晕厥患儿情绪障碍的相关性[J]. 山东大学学报 (医学版), 2025, 63(5): 71-78.

LI Ling, YAN Yuhan, KONG Qingyu, WANG Minmin, ZHAO Haizhao, ZHAO Cuifen. Correlation between orthostatic intolerance symptom scores, catecholamine and emotional disorders in children with vasovagal syncope[J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 71-78.

参考文献

[1] Hockin BCD, Heeney ND, Whitehurst DGT, et al. Evaluating the impact of orthostatic syncope and presyncope on quality of life: a systematic review and meta-analysis[J]. Front Cardiovasc Med, 2022, 9: 834879. doi:10.3389/fcvm.2022.834879
[2] Grimaldi CT, Fiorilli C, Placidi S, et al. What factors influence parents perception of the quality of life of children and adolescents with neurocardiogenic syncope [J]. Health Qual Life Outcomes, 2016, 14: 79. doi:10.1186/s12955-016-0476-9
[3] Abuzainah B, Gutlapalli SD, Chaudhuri D, et al. Anxiety and depression as risk factors for vasovagal syncope and potential treatment targets: a systematic review[J]. Cureus, 2022, 14(12): e32793.
[4] Hatoum T, Raj S, Sheldon RS. Current approach to the treatment of vasovagal syncope in adults[J]. Intern Emerg Med, 2023, 18(1): 23-30.
[5] Romme JJCM, van Dijk N, Go-Schön IK, et al. Association between psychological complaints and recurrence of vasovagal syncope[J]. Clin Auton Res, 2011, 21(6): 373-380.
[6] Kara A, Do an MT. The psychopathology, depression, and anxiety levels of children and adolescents with vasovagal syncope: a case-control study[J]. J Nerv Ment Dis, 2021, 209(8): 547-551.
[7] Liu Y, Zhao J, Guo W. Emotional roles of mono-aminergic neurotransmitters in major depressive disorder and anxiety disorders[J]. Front Psychol, 2018, 9: 2201.doi:10.3389/fpsyg.2018.02201
[8] Nguyen C, Mondoloni S, Le Borgne T, et al. Nicotine inhibits the VTA-to-amygdala dopamine pathway to promote anxiety[J]. Neuron, 2021, 109(16): 2604-2615.
[9] Gosmann NP, Costa MA, Jaeger MB, et al. Incidence of adverse events and comparative tolerability of selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for the treatment of anxiety, obsessive-compulsive, and stress disorders: a systematic review and network meta-analysis[J]. Psychol Med, 2023, 53(9): 3783-3792.
[10] Wang Y, Wang X, Wang K, et al. Chronic stress accelerates glioblastoma progression via DRD2/ERK/β-catenin axis and Dopamine/ERK/TH positive feedback loop[J]. J Exp Clin Cancer Res, 2023, 42(1): 161.
[11] 中华医学会儿科学分会心血管学组, 《中华儿科杂志》编辑委员会, 北京医学会儿科学分会心血管学组, 等. 儿童晕厥诊断指南(2016年修订版)[J]. 中华儿科杂志, 2016, 54(4): 246-250.
[12] 蔡虹, 吴礼嘉, 林萍, 等. 直立不耐受症状评分对儿童及青少年直立不耐受的诊断价值[J]. 中华实用儿科临床杂志, 2018, 33(1): 28-31. CAI Hong, WU Lijia, LIN Ping, et al. The value of orthostatic intolerance symptom scores on the diagnosis of orthostatic intolerance in children and adolescents[J]. Chinese Journal of Applied Clinical Pediatrics, 2018, 33(1): 28-31.
[13] 周惠清, 李定国, 宋艳艳, 等. 全国城市中小学生焦虑情绪流行病学调查[J]. 上海交通大学学报(医学版), 2007, 27(11): 1379-1381. ZHOU Huiqing, LI Dingguo, SONG Yanyan, et al. Epidemiologic study of anexity state in adolescents in China[J]. Journal of Shanghai Jiao Tong University(Medical Science), 2007, 27(11): 1379-1381.
[14] 王凯, 苏林雁, 朱焱, 等. 儿童焦虑性情绪障碍筛查表的中国城市常模[J].中国儿童心理学杂志, 2022, 10(4): 270-272. WANG Kai, SU Yanlin, ZhU Yan, et al. Norms of the screen for child anxiety related emotional disorders in chinese urban children[J]. Chinese Journal of Clinical Psychology, 2022, 10(4): 270-272.
[15] 王熙, 孙莹, 安静, 等. 中国儿童青少年抑郁症状性别差异的流行病学调查[J]. 中华流行病学杂志, 2013, 34(9): 893-896. WANG Xi, SUN Ying, AN Jing, et al. Gender difference on depressive symptoms among Chinese children and adolescents[J]. Chinese Journal of Epidemiology, 2013, 34(9): 893-896.
[16] 王君, 张洪波, 胡海利, 等. 儿童抑郁量表信度和效度评价[J]. 现代预防医学, 2010, 37(9): 1642-1645. WANG Jun, ZHANG Hongbo, HU Haili, et al. Reliability and validity testing on the child depression inventory in Hefei[J]. Modern Preventive Medicine, 2010, 37(9): 1642-1645.
[17] Alhuzaimi A, Aljohar A, Alhadi AN, et al. Psychiatric traits in patients with vasovagal and unexplained syncope[J]. Int J Gen Med, 2018, 11: 99-104. doi:10.2147/IJGM.S157335
[18] 丁异熠, 王成, 吴礼嘉, 等. 血管迷走性晕厥儿童的心理因素[J]. 实用儿科临床杂志, 2010, 25(6): 437-439. DING Yiyi, WANG Cheng, WU Lijia, et al. Psychological factors of children with vasovagal syncope[J]. Chinese Journal of Applied Clinical Pediatrics, 2010, 25(6): 437-439.
[19] 杨蓉, 刘中梅. 血管迷走性晕厥与焦虑抑郁的相关性探讨[J]. 心血管病学进展, 2019, 40(4): 579-582. YANG Rong, LIU Zhongmei. Vasovagal syncope and anxiety and/or depression[J]. Advances in Cardiovascular Diseases, 2019, 40(4): 579-582.
[20] 谢薇, 林涛. 血管迷走性晕厥伴焦虑患者经颅多普勒联合直立倾斜试验的特点分析[J].实用医院临床杂志, 2024, 21(5): 153-156. XIE Wei, LIN Tao. Analysis of characteristics of transcranial Doppler combined with upright tilt test in patients with vasovagal syncope and anxiety[J]. Practical Journal of Clinical Medicine, 2024, 21(5): 153-156.
[21] Winker R, Barth A, Dorner W, et al. Diagnostic management of orthostatic intolerance in the workplace[J]. Int Arch Occup Environ Health, 2003, 76(2): 143-150.
[22] Rafanelli C, Gostoli S, Roncuzzi R, et al. Psychological correlates of vasovagal versus medically unexplained syncope[J]. Gen Hosp Psychiatry, 2013, 35(3): 246-252.
[23] 薛奕童. 基于卷积神经网络构建抑郁症脑电微状态识别模型研究[D]. 重庆: 陆军军医大学, 2022.
[24] 马卓. 基于脑机接口的高性能精神状态检测系统研究[D]. 北京: 北京工业大学, 2022.
[25] Bandelow B, Baldwin D, Abelli M, et al. Biological markers for anxiety disorders, OCD and PTSD: a consensus statement. part II: neurochemistry, neurophysiology and neurocognition[J]. World J Biol Psychiatry, 2017, 18(3): 162-214.
[26] Cabrera Y, Koymans KJ, Poe GR, et al. Overnight neuronal plasticity and adaptation to emotional distress[J]. Nat Rev Neurosci, 2024, 25: 253-271. doi: 10.1038/s41583-024-00799-w
[27] Vahid-Ansari F, Zahrai A, Daigle M, et al. Chronic desipramine reverses deficits in cell activity, norepinephrine innervation, and anxiety-depression phenotypes in fluoxetine-resistant cF1ko mice[J]. J Neurosci, 2024, 44(3): e1147232023.
[28] Wu C, He J, Zhu Y, et al. Ultrasound neuromodulation ameliorates chronic corticosterone-induced depression- and anxiety-like behaviors in mice[J]. J Neural Eng, 2023, 20(3). doi: 10.1088/1741-2552/acdea9
[29] Hughes JW, Watkins L, Blumenthal JA, et al. Depression and anxiety symptoms are related to increased 24-hour urinary norepinephrine excretion among healthy middle-aged women[J]. J Psychosom Res, 2004, 57(4): 353-358.
[30] Paine NJ, Watkins LL, Blumenthal JA, et al. Association of depressive and anxiety symptoms with 24-hour urinary catecholamines in individuals with untreated high blood pressure[J]. Psychosom Med, 2015, 77(2): 136-144.
[31] 周扬, 李盈, 刘怿敏, 等. 星状神经节阻滞在焦虑相关睡眠障碍治疗中的应用[J]. 中国神经免疫学和神经病学杂志, 2024, 31(6): 468-471. ZHOU Yang, LI Ying, LIU Yimin, et al. Application of stellate ganglion block in the treatment of anxiety-related sleep disorders[J]. Chinese Journal of Neuroimmunology and Neurology, 2024, 31(6): 468-471.
[32] 解欣然, 禚凤, 杨楹, 等. 青少年抑郁障碍与多种心理行为问题的网络分析[J]. 山东大学学报(医学版), 2024, 62(12): 49-58. XIE Xinran, ZHUO Feng, YANG Ying, et al. A network analysis of adolescent depressive disorders and multiple psycho-behavioural problems[J]. Journal of Shandong University(Health Science), 2024, 62(12): 49-58.
[33] Walsh KE, Baneck T, Page RL, et al. Psychogenic pseudosyncope: not always a diagnosis of exclusion[J]. Pacing Clin Electrophysiol, 2018, 41(5): 480-486.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed