| Background and ObjectivesOrthostatic intolerance(0I)usually mediated by autonomic nerve,it usually appears in an upright position,but rarely in other positions.When transitioning to a supine position,the symptoms will be alleviated.OI is divided into four common subtypes:vasovagal syncope(VVS),orthostatic hypotention(OH),postural tachycardia syndrome(POTS),and orthostatic hypertension(OHT).Recurrent episodes of OI can lead to accidental injury or different degrees of mental illness in children,seriously affecting their physical and mental health.However,few studies have been conducted on the causes and predictive indicators of OI recurrence in children.In this study,the relationship between catecholamines and electrolytes levels in blood and urine of children with OI was analyzed to explore the predictive value of catecholamines and electrolytes for OI recurrence in order to improve the prognosis.Methods1.Clinical data collection204 children diagnosed and treated with "VVS","VVS combined with POTS(VVS+POTS)" in the pediatrics department of Shandong University Qilu Hospital from January 2016 to September 2021 were retrospectively collected.The data included name,sex,age,urine volume,clinical manifestation,inducements ect.2.Sample collection and detect methodAdopt high performance liquid phase mass spectrum(HPLC-MS/MS)to detect urinary epinephrine,norepinephrine,dopamine;apply ion selective electrode method to detect blood and urinary sodium,potassium,chlorine,calcium,phosphorus;adopt magnetic particle chemiluminescence method to detect plasma renin,aldosterone,and angiotensin Ⅱ.3.Group divide and follow-upThe children were divided into relapse group(recurrence within 1 year)and non-recurrence group(no recurrence within 1 year).All the enrolled children were followed-up through telephone and outpatient.4.Statistical analysis① The name,sex,age,urine volume,clinical manifestations and causes of seizures of children in VVS and VVS+POTS group were analyzed by EXCEL software,and the syncope characteristics of children in different groups were compared.② SPSS25.0 analysis software was used to conduct inter-group and intra-group univariate analysis and Logistic multivariate analysis for the two groups,so as to explore the factors affecting the recurrence of OI children.③Evaluate the predictive value of various indicators on the recurrence of VVS,VVS+POTS in children through receiver operating characteristic(ROC)curves.Results1.Analysis of general data of OI children(1)Analysis of attack inducement in VVS group:In the VVS group,there were more preonset precursors in the relapse group than in the non-relapse group.The most common inducements were exercise,standing for a long time,exercise,pain stimulation,position change,emotional agitation,etc.(2)Analysis of predisposing factors in VVS+POTS group:More children in VVS+POTS group had causes before onset than those without obvious causes.The most common causes were standing for a long time,activities,sports,emotional agitation and so on.2.Comparision of the plasma catecholamine,blood and urine electrolyte in VVS Group A total of 204 cases were included in the study,including 43 cases(21.08%)in the recurrence group and 161 cases(78.92%)in the non-recurrence group.(1)Relapse group versus non-relapse group:urinary epinephrine and urinary norepinephrine were statistically different between the two groups(P<0.05),but the rest were not statistically different;logistic multi-factor regression analysis showed that high urinary epinephrine levels were an independent risk factor for recurrence of VVS in children(P<0.01).(2)Men in the relapse group versus women in the relapse group:urinary norepinephrine and blood potassium were statistically different between the two groups(P<0.05),but no statistical differences were found in the rest.(3)Men in the non-relapse group versus women in the non-relapse group:urinary epinephrine(P<0.01)and blood phosphorus(P<0.001)were statistically different between the two groups,but no statistical differences were found in the rest.(4)Men in the relapse group versus men in the non-relapse group:There was a statistically significant difference in urine epinephrine(P<0.01)between men in the relapse group and men in the non-relapse group,but no statistical difference was found in the rest of the groups.(5)There was a statistically significant difference in blood potassium(P<0.01)between women in the relapse group and women in the non-relapse group,but no statistical difference was found in the rest of the groups.(6)Receiver operating characteristic(ROC)curve analysis:the area under the curve(AUC)for urinary epinephrine to predict recurrence in children with VVS was 0.617(95%CI 0.510-0.723),the optimal cut-off value was 5.62ug/24h,and the sensitivity and specificity were 0.488 and 0.801,respectively;the AUC for urinary norepinephrine to predict recurrence in children with VVS was The AUC of urinary norepinephrine in predicting recurrence in children with VVS was 0.557(95%CI 0.458-0.655),and the optimal critical value is 33.50ug/24h,with sensitivity and specificity of 0.256 and 0.882 respectively;the AUC of urinary epinephrine combined with urinary norepinephrine was 0.363,which had no predictive value.3.Comparision of the plasma catecholamine,blood and urine electrolyte in VVS combined POTS group:The total number of subjects included in this study was 73,including 18 patients(24.66%)in the relapsed group and 55 patients(75.34%)in the non-relapsed group.(1)Relapsed group and non-relapsed group:There were statistical differences in urinary adrenalin(P<0.001),urinary norepinephrine(P<0.05),urinary potassium(P<0.05)and urinary phosphorus(P<0.05)between the two groups,but no statistical differences were found.Logistic multivariate regression analysis showed that increased urinary adrenalin combined with decreased urinary potassium and urinary phosphorus were risk factors for recurrence in children with POTS and VVS.(2)Males and females in the relapse group:There were statistical differences in urine sodium(P<0.01),urine chlorine(P<0.01)and blood potassium(P<0.05)between the two groups,but no other statistical differences.(3)Men in the non-relapse group versus women in the non-relapse group:urinary epinephrine(P<0.01)and blood magnesium(P<0.05)were statistically different between the two groups,and the rest were not statistically different.(4)Men in the relapse group versus men in the non-relapse group:no statistical differences were seen in any of the influencing factors.(5)Women in the relapse group versus women in the non-relapse group:urinary potassium(P<0.05),urinary sodium(P<0.05),urinary chloride(P<0.05),urinary phosphorus(P<0.01),and blood calcium(P<0.05)were statistically different between the two groups.urinary chloride(P<0.05),urinary phosphorus(P<0.01),and blood calcium(P<0.05)were statistically different between the two groups,and the rest were not statistically different.(6)ROC curve analysis:the AUC for urinary norepinephrine to predict recurrence in children with VVS+POTS was 0.612(95%CI 0.429-0.796),the optimal critical value is 16.74ug/24h,with sensitivity and specificity of 0.909 and 0.368 respectively;the AUC for urinary epinephrine to predict recurrence in children with VVS+POTS was 0.738(95%CI 0.577-0.899),the best cut-off value was 5.53ug/24h,the sensitivity was 0.545.The AUC of urinary potassium,urinary phosphorus,urinary epinephrine combined with urinary norepinephrine,and urinary potassium combined with urinary phosphorus was<0.5,which had no predictive value.Conclusions1.Most of the OI children have predisposing factors before the onset of syncope,and the proportion of predisposing factors in the recurrent group has no statistical differences with that in the non-recurrent group.2.Ureinephrine and urenorepinephrine can be used as reference indicators to predict the recurrence of VVS children.When ureinephrine is greater than 5.62ug/24h,the probability of recurrence is higher.3.Urinary epinephrine and urinary norepinephrine can be used as reference indicators to predict recurrence in children with VVS combined with POTS,and recurrence is more likely when urinary epinephrine is greater than 5.53ug/24h. |
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