视-眼动系统平衡功能检测技术对眩晕性疾病的定位诊断价值研究
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摘要
目的探讨视-眼动系统平衡功能检测技术对眩晕性疾病的定位诊断价值。方法选取2015年1月—2016年6月开滦总医院收治的周围性眩晕患者166例作为周围性眩晕组,中枢性缺血性血管源性眩晕患者162例作为中枢性眩晕组,同期体检健康志愿者50例作为对照组。所有受试者进行视-眼动系统平衡功能检测,检测项目包括凝视试验、扫视试验、平稳跟踪试验、视动单速试验、视动正弦试验。结果 (1)凝视试验:对照组、周围性眩晕组无一例受试者出现凝视性眼震,中枢性眩晕组患者中28例出现正中位凝视性眼震、23例出现向左位凝视性眼震、25例出现向右位凝视性眼震。(2)扫视试验:中枢性眩晕组患者水平向左、向右扫视速度,水平向左、向右扫视精准度低于对照组、周围性眩晕组,水平向左、向右扫视延迟时间长于对照组、周围性眩晕组(P<0.05);周围性眩晕组患者水平向左扫视速度、水平向左扫视精准度低于对照组,水平向左扫视延迟时间长于对照组(P<0.05)。(3)平稳跟踪试验:中枢性眩晕组患者水平向左、向右平稳跟踪曲线增益低于对照组、周围性眩晕组,平稳跟踪左右不对称比、平稳跟踪相位差高于对照组、周围性眩晕组,周围性眩晕组患者平稳跟踪左右不对称比高于对照组(P<0.05)。(4)视动单速试验:中枢性眩晕组患者水平向左、向右视动单速眼震增益低于对照组、周围性眩晕组,视动单速左右不对称比高于对照组、周围性眩晕组(P<0.05)。(5)视动正弦试验:中枢性眩晕组患者水平向左、向右视动正弦眼震增益低于对照组、周围性眩晕组,视动正弦左右不对称比、视动正弦相位差高于对照组、周围性眩晕组(P<0.05)。结论周围性眩晕患者主要出现轻度扫视试验异常,而中枢性血管源性眩晕患者凝视试验、扫视试验、平稳跟踪试验、视动单速试验及视动正弦试验均会出现异常改变;视-眼动系统平衡功能检测技术可为眩晕性疾病的定位诊断提供客观依据。
Objective To investigate etiologic diagnostic value of balance function detection technology of visual-eye movement system on vertigo. Methods From January 2015 to June 2016,a total of 166 patients with peripheral vertigo were selected as A group in Kailuan General Hospital,a total of 162 patients with central ischemic vasogenic vertigo were selected as B group,meanwhile a total of 50 healthy volunteers admitted to this hospital for physical examination were selected as control group. All of the subjects received balance function detection of visual-eye movement system,including gaze test,saccade test,stationary visual tracking test,visual single-speed test,visual sine test. Results(1)Gaze test:No one in control group or A group occurred gaze nystagmus,while 28 cases occurred midline gaze nystagmus,23 cases occurred left gaze nystagmus and 25 cases occurred right gaze nystagmus in B group.(2)Saccade test:horizontal saccade speed to the left and right,horizontal saccade accuracy to the left and right in B group were statistically significantly lower than those in control group and A group,while horizontal saccade delay time to the left and right in B group was statistically significantly longer than that in control group and A group,respectively(P<0.05);horizontal saccade speed to the left and horizontal saccade accuracy to the left in A group were statistically significantly lower than those in control group,while horizontal saccade delay time to the left in A group was statistically significantly longer than that in control group(P<0.05).(3)Stationary visual tracking test:stationary visual tracking curve gain to the left and right in B group was statistically significantly lower than that in control group and A group,respectively,while stationary visual tracking left and right asymmetric ratio and stationary visual tracking phase difference in B group were statistically significantly higher than those in control group and A group,meanwhile stationary visual tracking left and right asymmetric ratio in A group was statistically significantly higher than that in control group(P<0.05).(4)Visual single-speed test:horizontal visual single-speed nystagmus gain to the left and right in B group was statistically significantly lower than that in control group and A group,respectively,while visual single-speed left and right asymmetric ratio in B group was statistically significantly higher than that in control group and B group,respectively(P<0.05).(5)Visual sine test:horizontal visual sinusoidal nystagmus gain to the left and right in B group was statistically significantly lower than that in control group and A group,respectively,while visual sinusoidal left and right asymmetric ratio and visual sinusoidal phase difference in B group was statistically significantly higher than that in control group and A group,respectively(P<0.05). Conclusion Peripheral vertigo patients mainly perform as light abnormity of saccade test,while central vertigo patients usually perform as abnormity gaze test,saccade test,stationary visual tracking test,visual single-speed test and visual sine test;balance function detection technology of visual-eye movement system can provide objective evidences for etiologic diagnosis of vertigo.
Objective To investigate etiologic diagnostic value of balance function detection technology of visual-eye movement system on vertigo. Methods From January 2015 to June 2016,a total of 166 patients with peripheral vertigo were selected as A group in Kailuan General Hospital,a total of 162 patients with central ischemic vasogenic vertigo were selected as B group,meanwhile a total of 50 healthy volunteers admitted to this hospital for physical examination were selected as control group. All of the subjects received balance function detection of visual-eye movement system,including gaze test,saccade test,stationary visual tracking test,visual single-speed test,visual sine test. Results(1)Gaze test:No one in control group or A group occurred gaze nystagmus,while 28 cases occurred midline gaze nystagmus,23 cases occurred left gaze nystagmus and 25 cases occurred right gaze nystagmus in B group.(2)Saccade test:horizontal saccade speed to the left and right,horizontal saccade accuracy to the left and right in B group were statistically significantly lower than those in control group and A group,while horizontal saccade delay time to the left and right in B group was statistically significantly longer than that in control group and A group,respectively(P<0.05);horizontal saccade speed to the left and horizontal saccade accuracy to the left in A group were statistically significantly lower than those in control group,while horizontal saccade delay time to the left in A group was statistically significantly longer than that in control group(P<0.05).(3)Stationary visual tracking test:stationary visual tracking curve gain to the left and right in B group was statistically significantly lower than that in control group and A group,respectively,while stationary visual tracking left and right asymmetric ratio and stationary visual tracking phase difference in B group were statistically significantly higher than those in control group and A group,meanwhile stationary visual tracking left and right asymmetric ratio in A group was statistically significantly higher than that in control group(P<0.05).(4)Visual single-speed test:horizontal visual single-speed nystagmus gain to the left and right in B group was statistically significantly lower than that in control group and A group,respectively,while visual single-speed left and right asymmetric ratio in B group was statistically significantly higher than that in control group and B group,respectively(P<0.05).(5)Visual sine test:horizontal visual sinusoidal nystagmus gain to the left and right in B group was statistically significantly lower than that in control group and A group,respectively,while visual sinusoidal left and right asymmetric ratio and visual sinusoidal phase difference in B group was statistically significantly higher than that in control group and A group,respectively(P<0.05). Conclusion Peripheral vertigo patients mainly perform as light abnormity of saccade test,while central vertigo patients usually perform as abnormity gaze test,saccade test,stationary visual tracking test,visual single-speed test and visual sine test;balance function detection technology of visual-eye movement system can provide objective evidences for etiologic diagnosis of vertigo.
引文
[1]田军茹,赵性泉.前庭疾病国际分类方向下眩晕疾病的临床诊疗思维及治疗原则[J].中华内科杂志,2016,55(10):746-749.DOI:10.3760/cma.j.issn.0578-1426.2016.10.002.
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[9]张云美,杨振栋,于亚峰.眼震视图在多管性良性阵发性位置性眩晕精确定位中的作用[J].临床耳鼻咽喉头颈外科杂志,2016,30(18):1435-1437.DOI:10.13201/j.issn.1001-1781.2016.18.003.
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[12]薛海龙,肖文,李仓霞.周围性眩晕和中枢性眩晕电生理特点的比较[J].临床神经病学杂志,2015,28(4):262-264.
[13]林细康,季晓林,罗高青,等.后循环缺血性眩晕患者的前庭功能变化[J].中国耳鼻咽喉头颈外科,2016,23(12):686-690.DOI:10.16066/j.1672-7002.2016.12.002.
[14]VONBREVERNM,BERTHOLONP,BRANDTT,等.良性阵发性位置性眩晕诊断标准[J].焉双梅,张欢,杨旭,等译.中国全科医学,210,20(11):1275-1281.DOI:10.3969/j.issn.1007-9572.2017.11.001.
[15]徐志伟,桑文文,王伟英,等.后循环梗死患者的眼动及前庭功能评价[J].中国卒中杂志,2015,10(5):383-390.DOI:10.3969/j.issn.1673-5765.2015.05.003.
[2]AN S Y,KIM B J,SUH M W,et al.Clinical roles of fixation suppression failure in dizzy patients in the ENT clinic[J].Acta oto-laryngologica,2014,134(11):1134-1139.DOI:10.3109/00016489.2014.936623.
[3]吴子明,蒋子栋.头晕与眩晕诊疗攻略[M].北京:中国协和医科大学出版社,2016.
[4]孙小英,赵性泉,鞠奕.前庭中枢性及周围性眩晕患者视频眼震图参数特点分析[J].中国卒中杂志,2013,8(5):346-350.DOI:10.3969/j.issn.1673-5765.2013.05.008.
[5]中华医学会神经病学分会.眩晕诊治专家共识[J].中华神经科杂志,2010,43(5):369-374.DOI:10.3760/cma.j.issn.1006-7876.2010.05.016.
[6]田军茹.眩晕诊治[M].北京:人民卫生出版社,2015.
[7]STRUPP M,KREMMYDA O,ADAMCZYK C,et al.Central ocular motor disorders,including gaze palsy and nystagmus[J].J Neurol,2014,261(Suppl 2):S542-558.DOI:10.1007/s00415-014-7385-9.
[8]眩晕急诊诊断与治疗专家共识(周围性眩晕)[J].中国全科医学,2018,21(10):1150.
[9]张云美,杨振栋,于亚峰.眼震视图在多管性良性阵发性位置性眩晕精确定位中的作用[J].临床耳鼻咽喉头颈外科杂志,2016,30(18):1435-1437.DOI:10.13201/j.issn.1001-1781.2016.18.003.
[10]毕静,林鹏,陈太生,等.单侧前庭周围性眩晕的平稳跟踪实验结果分析[J].临床耳鼻咽喉头颈外科杂志,2010,24(1):8-10,15.DOI:10.3969/j.issn.1001-1781.2010.01.003.
[11]鞠奕,杨旭,赵性泉.血管源性中枢急性前庭综合征及其眼震形式[J].中国卒中杂志,2015,10(5):435-441.DOI:10.3969/j.issn.1673-5765.2015.05.010.
[12]薛海龙,肖文,李仓霞.周围性眩晕和中枢性眩晕电生理特点的比较[J].临床神经病学杂志,2015,28(4):262-264.
[13]林细康,季晓林,罗高青,等.后循环缺血性眩晕患者的前庭功能变化[J].中国耳鼻咽喉头颈外科,2016,23(12):686-690.DOI:10.16066/j.1672-7002.2016.12.002.
[14]VONBREVERNM,BERTHOLONP,BRANDTT,等.良性阵发性位置性眩晕诊断标准[J].焉双梅,张欢,杨旭,等译.中国全科医学,210,20(11):1275-1281.DOI:10.3969/j.issn.1007-9572.2017.11.001.
[15]徐志伟,桑文文,王伟英,等.后循环梗死患者的眼动及前庭功能评价[J].中国卒中杂志,2015,10(5):383-390.DOI:10.3969/j.issn.1673-5765.2015.05.003.