Isoproterenol 정주와 Nitrate 분무제를 이용한약물 유발 기립경사검사의 비교 = Comparison of Isoproterenol Infusion and Nitrate Spray during Provocative Head-Up Tilt Test

다국어 초록 (Multilingual Abstract)

Background and Objectives：The head-up tilt test (HUT) is widely used for the diagnosis of vasovagal syncope.To improve the sensitivity of the test, provocation with isoproterenol is frequently used. The aim of this study wasto evaluate the values of isosorbide dinitrate spray as a provocation drug in the HUT. Subjects and Methods：Two hundred patients, undergoing baseline HUT (60°for 20 minutes) for suspected vasovagal syncope or presyncopeand unexplained dizziness, were enrolled. If the baseline HUT was negative, isosorbide dinitrate (2.5 mg)spray was applied sublingually (group I, n=93), or isoproterenol (3 μg/min) infused (group II, n=93), in arandomized fashion. The values of isosorbide dinitrate and isoproterenol were compared in those patients thatdeveloped a positive vasovagal response or who completed the drug-provocative HUT. Results：Syncope was similarlyreproduced in both groups (47.7 vs. 41.9%, p>0.05). Type I responses were most common in both groups,and types I and II responses were more common in group I than group II (78.0 vs. 55.6% and 12.2 vs. 5.6%,p<0.05, respectively). The average time to a positive response was longer in group I than group II (8.5±3.4 vs.6.1±3.6 minutes, p<0.01). The sensitivity and specificity of the drug-provocative HUT were significantly higherin group I than group II (73.5 and 87.5% vs. 58.5 and 71.1%; respectively, p<0.01). The incidence of minor adverseeffects were similar in both groups, but serious cardiac side effects were significantly more common in group

국문 초록 (Abstract)

배경 및 목적：기립경사검사는 원인 불명 실신의 진단에 유용한 검사이며예민도를 높이기 위해 흔히 isoproterenol이 사용되고 있다.본 연구는 입안에 분무하여 투여할 수 있는 isosorbide dinitrate분무제를 이용한 기립경사검사의 유용성을 평가하기 위해 isoproterenol 유발 기립경사검사와 비교하였다.방 법：원인 불명 현기증이나 실신을 주소로 내원한 환자 200명Bora YanBora Yang, et al：Nitrate Spray Provocation Head-Up Tilt Test·695을 대상으로 하였다. 20분간 60도 경사로 기저 기립경사검사에서 실신이 발생한 14명을 제외한 186명에서 무작위로 isosorbidedinitrate(Isoket??) 분무제를 입안에 두 번(2.5 mg)뿌리거나(Ⅰ군), isoproterenol을 분당 3 μg의 속도로 정맥으로 20분 동안 주입하였다(Ⅱ군). 유발 약제의 유용성은 약물 부작용 때문에 검사를 도중에 중단한 14명을 제외한 172명을 대상으로 평가하였다.
결 과：
양 군 사이에 연령, 성별, 심혈관질환 위험인자, 실신의 정
도나 빈도, 기간 등은 유의한 차이가 없었다. 실신 재현은
Ⅰ군(n=86)에서 41예(47.7%), Ⅱ군에서 36예(41.9%) 있었다
(p>0.05). 양성 반응의 유형은 양 군 모두에서 Ⅰ형이 가장
많았으나 Ⅰ형과 Ⅱ형은 Ⅰ군에서 Ⅱ군에서 보다 더 많았다
(78% 대 55.6%, 12.2% 대 5.6%, p<0.05). 양성 반응이 나
타날 때까지 평균 시간은 Ⅰ군 8.5±3.4분, Ⅱ군 6.1±3.6분
으로 Ⅰ군에서 더 길었다(p<0.01). Isosorbide dinitrate 분
무제 유발 기립경사검사의 예민도와 특이도는 각각 73.5%,
87.5%여서 isoproterenol 유발 검사의 58.5%와 71.1%에 비해
의미 있게 더 높았다(p<0.01). 경미한 약물 부작용의 빈도는 양
군 사이에 의미 있는 차이가 없었으나 심각한 심장 부작용은
Ⅱ군에서만 4예(4.3%) 발생하여 Ⅰ군에 비해 높았다(p<0.05).
결 론：
기립경사검사에서 유발 약제로서 isosorbide dinitrate 분
무제는 isoproterenol에 비해 투여가 간편하며 부작용이 적
고 예민도, 특이도가 높아 원인 불명 실신 환자를 평가하는
데 유용할 것으로 생각된다.

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