소아청소년 실신 환자에서 기립 경사 검사의 유용성 = Effectiveness of head-up tilt test for the diagnosis of syncope in children and adolescents

다국어 초록 (Multilingual Abstract)

Purpose : We aimed to examine the effectiveness of the head-up tilt test (HUT) for the diagnosis of syncope or presyncope in children and adolescents.
Methods : HUT results and clinical features of 160 children and adolescents with syncope or presyncope were studied from May 2003 through March 2008 at the Chonbuk National University Hospital. The children and adolescents were subjected to 70° HUT for 45 minutes. The testees were divided into 2 groups: group I (children) comprising 39 children in the age range 7-12 years (mean, 10.59±1.60 years) and group II (adolescents) comprising 121 adolescents in the age range 13-20 years (mean, 15.93±2.28 years). Positive result rates of the HUT and types of hemodynamic response to the test in the 2 groups were compared.
Results : Of the 160 testees, 92 (57.5%) showed positive HUT results; they showed 3 patterns of response to tilting. Twelve patients showed a predominantly vasodepressor response; 10 patients showed a cardioinhibitory response; and 70 patients showed a mixed response. The positive result rates were 43.6% (17/39) and 62.0% (75/121) in groups I and II, respectively. Mixed response was the predominant positive hemodynamic response in both the groups.
Conclusion : The HUT is a useful diagnostic tool for evaluating the condition of pediatric patients, including adolescents, with syncope. Further, it may be considered as the first step for evaluating the condition of such patients.

국문 초록 (Abstract)

목 적 : 실신은 소아와 청소년들에게 흔히 발생되는 증상으로 혈관 미주신경성 실신이 가장 흔한 형태다. 이 연구의 목적은 원인불명의 실신 및 그와 유사한 증상으로 내원한 소아청소년기 환자들에게 기립 경사 검사(head-up tilt test, HUT)의 반응과 진단적 가치를 검토해 보고자 하였다.
방 법 : 2003년 5월부터 2008년 3월까지 전북대학교병원에 실신 및 실신 전 증상을 주소로 HUT를 하고 임상적으로 혈관 미주신경성 실신이 의심되는 160명(남 82명, 여 78명, 7-20세)을 대상으로 임상 양상 및 HUT 결과와 그 반응에 대해 의무기록을 통하여 후향적 조사를 시행하였다. HUT는 70도 경사에서 45분간 시행하였으며 일부는 isoproterenol 0.5-1.0 ug/min 주사를 이용하였으며 이 환아들을 소아군(7-12세, 39명, 10.59±1.60세), 청소년군(13-20세, 121명, 15.93±2.28세)으로 분류하여 두 군 간의 HUT 양성률과 그 반응유형을 비교해 보았다.
결 과 : 대상 환아 160명 중에서 양성반응인 환아는 92명(57.5 %)이었고, 남녀 비는 차이가 없었다. 양성 반응은 혼합형이 70례로 제일 흔한 반응이었고, 혈관억제형이 12례, 무수축을 동반하지 않은 심장억제형이 6례, 무수축을 동반한 심장억제형이 4례이었다. 실신의 원인을 규명하는데 HUT를 비롯하여 혈액흉부 방사선 촬영, 심전도와 24시간 holter 검사 및 운동부하검사, 뇌파 검사, 뇌 단층촬영과 뇌 자기공명검사, 심초음파 검사 등이 시행되었다. 또한 연령대에 따른 HUT의 양성 반응률 비교는 소아군 43.6% (17/39), 청소년군 62% (75/121)이었고, 혼합형 반응이 소아 군에서 15명(38.4%)에서 청소년군 55명(45.0%)으로 청소년군이 더 높은 양성률을 보였으나 두 그룹간의 통계학적으로 의미 있는 차이는 없었다.
결 론 : HUT는 혈관 미주신경성 실신이 의심되는 병력과 진찰 소견이 정상인 소아에서 여러 다른 검사 방법에 우선하여 시행함으로써 실신의 원인을 규명하는데 유용하다.

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