目的:体位性心动过速综合征(POTS)是一种慢性健康状况,主要影响育龄妇女,并显著影响他们的健康和生活质量。目前对没有批准的许可治疗方法了解甚少。这项系统评价的目的是将POTS的症状负担与背景联系起来,并回顾与这种负担相关的因素,这些因素可能会指导未来的治疗。具体问题是(1)POTS中的症状负担与其他长期疾病(LTC)中的负担相比,(2)哪些因素与POTS症状负担相关,(3)哪些干预措施显示出减轻POTS症状负担的希望。
方法:电子数据库(CENTRAL,MEDLINE,EMBASE,CINAHL,PsycINFO,WebofScience,APAPsycarticles,OpenGrey)从开始到2022年1月进行了搜索,以观察研究报告任何生物学,心理或社会因素和症状负担,和随机对照试验报告对成人POTS患者症状负担的干预措施。两名评审员独立进行资格筛选,数据提取和质量评估。进行了叙事综合。
结论:对5159个条目进行了资格筛选。纳入了29项研究(1372名POTS参与者,总样本量为2314、17高,12中等质量),17项为观察性试验,12项为随机对照试验和干预试验.证据的总体方法学质量中等高,但异质性高,样本量适中,允许适度稳健的结论。POTS的体位症状负担高于其他LTC。针对肾上腺素能α1受体的血清活性,身体机能,抑郁症,灾难,在中高质量研究中,长期认知压力测试和焦虑与症状负担显著相关.主要来自概念验证(n=11)研究和一项3个月2×2析因设计试验的初步中高质量证据表明,压缩服装,普萘洛尔,吡啶斯的明,去氨加压素,比索洛尔可能在减轻症状负担方面有希望。未来研究的方向包括随着时间的推移调查相关因素,发展复杂的干预措施,解决与症状负担相关的生物和社会心理因素,以及这些干预措施的有效性试验。
结论:POTS症状负担很高,特别是与其他长期疾病(LTC)相比,直立不耐受。尽管有这样的负担,没有有效的随机对照试验来减轻POTS中的症状。这篇综述为理解与这种负担相关的生物和社会心理因素提供了起点。然而,症状负担的测量存在不一致,降低交叉研究推论的信心。POTS症状范围的连贯定义,目前缺乏严重程度和影响以及经过验证和可靠的POTS专用仪器。评估POTS症状负担作为核心结果指标的标准化问卷将有助于阐明未来的研究和临床实践。
Postural Orthostatic Tachycardia Syndrome (POTS) is a chronic health condition affecting mostly women of childbearing age, and significantly impacting their health and quality of life. It is currently poorly understood with no approved licensed treatments. The aim of this systematic
review was to contextualize the symptom burden of POTS, and
review factors associated with this burden that may guide future treatments. The specific questions were (1) How does symptom burden in POTS compare to the burden in other long term conditions (LTCs), (2) Which factors are associated with POTS symptom burden, and (3) Which interventions show promise in reducing symptom burden in POTS.
Electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, APA PsycArticles, OpenGrey) were searched from inception to January 2022 for observational studies reporting on the association between any biological, psychological or social factors and symptom burden, and randomized controlled trials reporting on interventions for symptom burden in adults with POTS. Two reviewers independently conducted eligibility screening, data extraction and quality assessment. A narrative synthesis was undertaken.
5159 entries were screened for eligibility. Twenty-nine studies were included (1372 participants with POTS of a total sample size of 2314, 17 High-, 12 Medium-quality), seventeen were observational and twelve were randomized controlled experimental and intervention trials. Overall methodological quality of the evidence was medium-high but heterogeneity was high and sample sizes modest, allowing moderately robust conclusions. Orthostatic symptom burden was higher in POTS than other LTCs. Serum activity against adrenergic α1 receptors, physical functioning, depression, catastrophizing, prolonged cognitive stress testing and anxiety were significantly associated with symptom burden in medium-high quality studies. Preliminary medium-high quality evidence from predominantly proof-of-concept (n = 11) studies and one 3-month 2 × 2 factorial design trial suggest that compression garments, propranolol, pyridostigmine, desmopressin, and bisoprolol may hold promise in reducing symptom burden. Directions for future research include investigating associated factors over time, the development of complex interventions which address both biological and psychosocial factors associated with symptom burden, and effectiveness trials of these interventions.
POTS symptom burden is high, particularly in relation to orthostatic intolerance when compared to other long-term conditions (LTCs). Despite this burden, there are no effectiveness randomized controlled trials of treatment to reduce symptoms in POTS. This
review provides a starting point to understanding researched biological and psychosocial factors associated with this burden. There was however inconsistency in the measurement of symptom burden, lowering the confidence of cross-study inferences. A coherent definition of POTS symptom range, severity and impact along with a validated and reliable POTS-specific instrument is currently lacking. A standardized questionnaire to assess POTS symptom burden as a core outcome measure will help clarify future research and clinical practice.