DETERMINATION OF A NEW CRITERIA FOR ORTHOSTATIC DYSREGUATION

确定直立性失调的新标准

• 批准号: 07670917
• 负责人: TANAKA Hidetaka
• 金额: $ 1.15万
• 依托单位: OSAKA MEDICAL COLLEGE
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1995
• 资助国家: 日本
• 起止时间: 1995 至 1996
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-07670917/
• 关键词: Orthostatic dysregulation; Orthostatic test; Diagnostic criteria; orthostatic hypotenion; Adolescents; Orthostatic dizziness; FINAPRES; continuous blood pressure measurments

We determined the criteria for instantaneous orthostatic hypotension (INOH), a typical form of orthostatic dysregulation, from the reference data of 173 healthy children, aged 6 to 18 years. Also reported were clinical characteristics, circulatory and catecholamine responses to postural change in 44 children and young adults with instantaneous orthostatic hypotension (INOH) compared with 73 age matched controls. The criteria for INOH was as follows : group I (mild type), a 60% or greater decrease in mean blood pressure during the initial phase of standing, or blood pressure recovery time of more than 25 sec evaluated by a non-invasive finger arterial pressure monitoring system ; group II (severe type), prolonged reduction in systolic arterial pressure of more than 15% during the later stage of standing in addition to the criteria for group I.Sensitivity and specificity of this criteria were as high as 100% and 90.4%, respectively. Group I and group II showed significantly more pronounc … More ed reduction in BP) than normal controls at the initial drop (% reduction for systolic BP : -53+-12, -50+-6 vs.-32+-16, respectively, p<0.001), one minute of standing (-6+-10, -24+-18 vs.6+-12, p<0.001) and five minute of standing (-5+13, -21+-11 vs.8+-9, p<0.05). Plasma noradrenaline responses to standing were significantly lower in group I and group II than in controls after one minute of standing (50+-63,33+-39 vs.99+-56 pg/ml, respevtively), and were kept lower in group II after five minutes (218+-122,115+-78 vs.193+-98 pg/ml, respectively). The physical complaints included chronic fatigue (91% of the patients), orthostatic dizziness (88%), weakness (84%), sleep disturbance (73%), syncope or near syncope (68%), headache (68%), loss of apprtite (57%), abdominal pain (55%). Among these complaints chronic fatigue, loss of appetite, orthostatic dizziness, syncope and morning tiredness were specific for INOH.These results suggest that mechanisms responsible for INOH may depend on reduced noradrenaline secretion during orthostatic stress, associated with centrally mediated sympathetic inhibition. The patients in group II seemed to have more decreased sympathetic activation and thus more impaired quality of life than those in group I including school absenteeism. INOH is an important pathological condition in children with complaints of orthostatic intolerance and chronic fatigue. This can be identified when using a non-invasive beat-to-beat continuous blood pressure monitoring system. Less

我们根据173名6 ~ 18岁健康儿童的参考资料，确定了直立性低血压（INOH）的标准，INOH是直立性调节障碍的一种典型形式。还报告了44例儿童和年轻成人瞬时直立性低血压（INOH）的临床特征，循环和儿茶酚胺反应的姿势变化，与73名年龄匹配的对照。INOH的标准如下：I组（轻度型），站立初始阶段平均血压下降60%或以上，或通过无创指动脉压监测系统评估的血压恢复时间超过25秒;组II（严重型），动脉收缩压长期下降超过15%该标准的敏感性和特异性分别高达100%和90.4%。第一组和第二组的发音明显更多 ...更多信息 收缩压下降百分比：-53+-12，-50+-6 vs.-分别为32 ± 16，p<0.001）、站立1分钟（-6 ± 10，-24 ± 18 vs.6 ± 12，p<0.001）和站立5分钟（-5 ± 13，-21 ± 11 vs.8 ± 9，p<0.05）。站立1分钟后，组I和组II血浆去甲肾上腺素反应显著低于对照组（分别为50 ± 63、33 ± 39和99 ± 56 pg/ml），5分钟后组II仍保持较低水平（分别为218 ± 122、115 ± 78和193 ± 98 pg/ml）。躯体症状包括慢性疲劳（91%）、直立性头晕（88%）、乏力（84%）、睡眠障碍（73%）、晕厥或近晕厥（68%）、头痛（68%）、食欲减退（57%）、腹痛（55%）。在这些投诉慢性疲劳，食欲不振，直立性头晕，晕厥和早晨疲劳是具体的INOH。这些结果表明，负责INOH的机制可能取决于减少去甲肾上腺素分泌在直立性应激，与中枢介导的交感神经抑制。第二组的病人似乎有更多的减少交感神经激活，从而更多的损害生活质量比第一组，包括缺课。INOH是一种重要的病理条件，在儿童投诉直立不耐受和慢性疲劳。这可以在使用无创逐搏连续血压监测系统时识别。少

项目成果

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