【摘要】 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。更多还原

【Abstract】 Objective:To explore the circadian rhythm for the onset of neurally mediated syncope(NMS) in relevant patients. Methods:A total of 411 NMS patients treated in our hospital from 2013-12 to 2015-04 were studied. There were 165 male and 246 female at the age from 3 to 68(20.95±15.20) years including 262(63.7%) youth(<18 years). According to head-up tilt test(HUTT), the patients were divided into 2 groups:HUTT(+) group, n=281 and HUTT(-) group, n=130. The onset frequency and time frame were collected from patients or guardians and a 24 h day was divided into 4 periods as 06:00-12:00, 12:00-18:00, 18:00-24:00 and 00:00-06:00 O’clock.Results:(1) General data:there were 1085 syncope onsets occurred in 411 patients including 753 times in HUTT(+) group and 332 in HUTT(-) group. The onset had similar gender ratio between 2 groups, P>0.05, the patients’ age in HUTT(+) group was younger than HUTT(-) group, P<0.05.(2) Differences of onset frequency at various periods of the day:in all patients, the syncope onset was mostly occurred at 06:00-12:00 period, P<0.05. Compared with other periods, the onset in HUTT(+) group mainly happened at 06:00-12:00 period, P<0.05, HUTT(-) group had the similar trend while P>0.05; the onset frequency at various period was similar between 2 groups, P>0.05. In HUTT(+) group, different HUTT responses(except orthostatic hypotension and orthostatic hypertension) had similar onset frequency at various period, P>0.05.(3) Differences in gender and age:at 06:00-12:00 period, the onset in male was more than female and at 18:00-24:00 period, the onset in male was less than female, P<0.05. The younger the patients were, the more onsets were at 06:00-12:00 period, the older the patients were, the more onsets were at 00:00-06:00 period, P<0.001.Conclusion:The onset of syncope had circadian rhythm and it was mainly occurred at 06:00-12:00 period of the day. There were gender and age differences for the onset frequency during 4 periods of a day.更多还原