良性阵发性位置性眩晕手法复位后残余症状的相关因素分析
|
摘要
目的探讨良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)手法复位后残余症状的发生率及相关危险因素。方法 2017年3月至2018年3月确诊为BPPV并实施手法复位治疗的210例患者,根据治疗后有无残余症状分为有残余症状组和无残余症状组,分析残余症状的出现率及相关危险因素。结果本组210例BPPV患者除2例退出研究外,复位后残余症状的出现率为58.10%(122/210);单因素分析结果显示,发病月份、焦虑状态、伴糖尿病、伴高血压、血清25(OH)D_3浓度水平、复位次数、发病类型、血清半胱氨酸水平是出现残余症状的危险因素;多因素Logistics回归分析结果显示,发病月份、伴糖尿病、伴高血压、血清25(OH)D_3浓度水平、复位次数、发病类型、血清半胱氨酸水平是发生残余症状的危险因素。12～2月发病者血清25(OH)D_3浓度低于其他月份发病者。管结石症患者的血清25(OH)D_3水平低于嵴顶结石症患者。结论本组BPPV患者手法复位后残余症状的出现与发病月份、伴糖尿病和高血压、血清25(OH)D_3水平、血清半胱氨酸水平、发病类型及复位次数有关。
Objective To investigate the risk factors and the incidence of residual symptom after manipulative reduction of BPPV.Methods A total of 210 patients with BPPV in our hospital from March 2017 to March 2018 were included in this study. They were divided into two groups according to the appearance of "residual symptom" after manipulative reduction treatment. This paper investigates the related risk factors during different statistical methods.Results The incidence of residual symptom was 58.10%. For the single factor Chi-square test, P value of seasonal change, anxiety, diabetes mellitus, hypertension, 25(OH)D_3 concentration level, reduction times, paroxysm type and serum cysteine level were less than 0.05. The difference had statistical significance and they were the risk factors for residual symptom. Multivariate binary logistics regression analysis showed that seasonal change, diabetes mellitus, hypertension, 25(OH)D_3 concentration level, reduction times, paroxysm type, and serum cysteine level were the risk factors. For the relationship between BPPV paroxysm type, seasonal change and 25(OH)D_3 concentration level, the P value of the paroxysm type and seasonal change can be less than 0.001. The difference had statistical significance. June-August and September-November concentration value can be higher than December-February concentration value. September-November and June-August concentration value can be higher than March-May concentration value( P<0.05).The difference had statistical significance. There was no significance between March-May concentration and December-February concentration values(P>0.05). For the DHI rating table, the difference of DHI scores had no statistical significance before manipulative reduction. After manipulative reduction, the DHI scores between the two groups were compared( P<0.05). The difference had statistical significance. In the longitudinal comparison, the difference of DHI scores had no statistical significance in emotion and functions of the DHI score among the patients in the residual symptom group while The difference had statistically significance( P<0.05) in the non-residual symptom group before and after manipulative reduction.Conclusion The incidence of residual symptom after the manipulative reduction of BPPV was 58.10% combined with two statistical methods, seasonal change, diabetes mellitus, hypertension, serum 25(OH)D_3 level, the number of resets and the paroxysm type are the risk factors of BPPV occurrence. Among the patients with residual symptoms of BPPV, and 25(OH)D_3 concentration level, seasonal change and paroxysm type show the relevance. The 25(OH)D_3 concentration level of patients with duct lithiasis can be lower than that of patients with cupulolithiasis. The level of 25(OH)D_3 concentration level can be positively correlated with the seasonal change. The life quality of BPPV patients with residual symptoms decreases significantly and the residual symptom can be an important factor that injures the life quality of patients.
Objective To investigate the risk factors and the incidence of residual symptom after manipulative reduction of BPPV.Methods A total of 210 patients with BPPV in our hospital from March 2017 to March 2018 were included in this study. They were divided into two groups according to the appearance of "residual symptom" after manipulative reduction treatment. This paper investigates the related risk factors during different statistical methods.Results The incidence of residual symptom was 58.10%. For the single factor Chi-square test, P value of seasonal change, anxiety, diabetes mellitus, hypertension, 25(OH)D_3 concentration level, reduction times, paroxysm type and serum cysteine level were less than 0.05. The difference had statistical significance and they were the risk factors for residual symptom. Multivariate binary logistics regression analysis showed that seasonal change, diabetes mellitus, hypertension, 25(OH)D_3 concentration level, reduction times, paroxysm type, and serum cysteine level were the risk factors. For the relationship between BPPV paroxysm type, seasonal change and 25(OH)D_3 concentration level, the P value of the paroxysm type and seasonal change can be less than 0.001. The difference had statistical significance. June-August and September-November concentration value can be higher than December-February concentration value. September-November and June-August concentration value can be higher than March-May concentration value( P<0.05).The difference had statistical significance. There was no significance between March-May concentration and December-February concentration values(P>0.05). For the DHI rating table, the difference of DHI scores had no statistical significance before manipulative reduction. After manipulative reduction, the DHI scores between the two groups were compared( P<0.05). The difference had statistical significance. In the longitudinal comparison, the difference of DHI scores had no statistical significance in emotion and functions of the DHI score among the patients in the residual symptom group while The difference had statistically significance( P<0.05) in the non-residual symptom group before and after manipulative reduction.Conclusion The incidence of residual symptom after the manipulative reduction of BPPV was 58.10% combined with two statistical methods, seasonal change, diabetes mellitus, hypertension, serum 25(OH)D_3 level, the number of resets and the paroxysm type are the risk factors of BPPV occurrence. Among the patients with residual symptoms of BPPV, and 25(OH)D_3 concentration level, seasonal change and paroxysm type show the relevance. The 25(OH)D_3 concentration level of patients with duct lithiasis can be lower than that of patients with cupulolithiasis. The level of 25(OH)D_3 concentration level can be positively correlated with the seasonal change. The life quality of BPPV patients with residual symptoms decreases significantly and the residual symptom can be an important factor that injures the life quality of patients.
引文
1 Nguyen-Huynh AT.Evidence-based practice:management of vertigo[J].Otolaryngol Clin North Am,2012,45:925.
2 Walther LE.Procedures for restoring vestibular disorderal[J].GMS Curr Top Otorhinolaryngol Head Neck Surg,2005,4:5.
3 Teggi R,Giordano L,Bondi S,et al.Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly [J].Eur Arch Otorhinolaryngol,2011,268:507.
4 Teggi R,Giordano L,Bondi S,et al.Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly[J].Eur Arch Otorhinolaryngol,2011,268:207.
5 刘晓薇,孙敬武,张波,等.良性阵发性位置性眩晕成功复位后残余头晕的危险因素分析[J].听力学及言语疾病杂志,2018,26:148.
6 Bhattaeharyya N,Reginald F,Baugh F,et al.Clinical practice guideline:Benign paroxysmal positional vertigo[J].Otolaryngology Head Neck Surg,2008,139(5 Suppl4):47.
7 Seok JI,Lee HM,Yoo JH,et al.Residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo[J].J Clin Neurol,2008,4:107.
8 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科学分会.良性阵发性位置性眩晕的诊断与治疗指南[J].中华耳鼻咽喉头颈外科杂志,2017,52:173.
9 张作记.行为医学量表手册[M].北京:中华医学电子音像出版社,2005.213～223.
10 Sharpley CF,Christh IE DR.Ananalys is of the psychometric Profile and frequency of anxiety and depression in Australian men with prostate cancer[J].Psychoon Cology,2007,16:660.
11 刘贤臣,唐茂芹,胡蕾,等.匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志,1996,29:103.
12 闫亚平,张淑香.特发性良性阵发性位置性眩晕发病危险因素研究进展[J].中国中西医结合耳鼻咽喉科杂志,2017,25:392.
13 Vrane?i■ Bender D,Giljevi■ Z,Ku?ec V,et al.Guidelines for the prevention,detection and therapy of vitamin D deficiency in adults[J].Lije■ Vjesn,2016,138:1.
14 Micarelli A,Viziano A,Alessandrini M.A comprehensive insight into the rehabilitative treatment of persistentbenign paroxysmal positional vertigo[J].J Int Adv Otol,2017,13:147.
15 Kim HA,Lee H.Autonomic dysfunction as a possible cause of residual dizziness after successful treatment in benign paroxysmal positional vertigo[J].Clinical Neurophysiology,2014,125:608.
16 Farally M,Lapenna R,Giommetti G,et al.Residual dizziness after the first BPPV episode:role of otolithic function and of a delayed diagnosis[J].Eur Arch Otorhinolaryngol,2016,273:3157.
17 Faralli M,Manzari L,Panichi R,et al.Subjective visual vertical before and after treatment of a BPPV episode[J].Auris Nasus Larynx,2011,38:307.
18 李斐,肖本杰,陈瑛,等.良性阵发性位置性眩晕复位后残余症状持续时间和病因分析[J].第二军医大学学报,2018,2:216.
19 胡进,傅伟达,尤克,等.继发性和原发性良性发作性位置性眩晕残余头晕症状的比较[J].中华全科医学,2017,10:1694.
20 D'Silva LJ,Staecker H,Lin J,et al.Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension[J].J Vestib Res,2016,25:233.
21 Martellucci S,Pagliuca G,de Vincentiis M,et al.Features of residual dizziness after canalith repositioning procedures for benign paroxysmal positional vertigo[J].Otolaryngology-Head and Neck Surgery,2016,154:693.
22 Chen ZJ,Chang CH,Hu LY,et al.Increased risk ofbenign paroxysmal positional vertigoin patients with anxiety disorders:a nationwide population-based retrospective cohort study[J].BMC Psychiatry,2016,16:238.
23 于新军,孙宝梅.良性阵发性位置性眩晕病因学研究[J].北京医学,2017,8:770.
24 岳伟,相蕾,张雅静,等.老年人良性阵发性位置性眩晕与颅内外血管病变的关系[J].中华老年医学杂志,2014,33:355.
25 De Stefano A,Dispenza F,Suarez H,et al.A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo[J].Auris Nasus Larynx,2014,41:31.
26 Celikbilek A,Gencer ZK,Saydam L,et al.Serum uric acid levels correlate with benign paroxysmal positional vertigo[J].Eur J Neurol,2014,21:79.
27 刘韵,王伟,龚树生.310例良性阵发性位置性眩晕患者发病相关因素分析[J].临床耳鼻咽喉头颈外科杂志,2016,9:748.
28 Sheikhzadeh M,Lotfi Y,Mousavi A,et al.Influence of supplemental Vitamin D on intensity of benign paroxysmal plsitional vertigo:a longitudinal clinical study[J].Caspian J Intern Med,2016,7:93.
29 Talaat HS,Kabel AM,Khaliel LH,et al.Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency[J].Auris Nasus Larynx,2016,43:237.
30 顾湘,董飞林,顾建华.良性阵发性位置性眩晕患者血清25羟维生素D水平研究[J].临床耳鼻咽喉头颈外科杂志,2017,31:924.
31 Maslovara S,Sollos B,Sestak A,et al.25(OH)D3 levels,in cideme and recurrence of different clinical forms of BPPV[J].Braz Otorhin Olarungol,2017,5:1.
32 贾永林,付志新,张宝华.良性发作性位置性眩晕手法复位后残余症状分析[J].中国实用神经疾病杂志,2017,20:12.
33 Gacek RR,Gacek MR.The three faces of vestibular ganglionitis[J].Ann Otol Rhinol Laryngol,2002,111:103.
34 Zapala DA,Shapiro SA,Lundy LB,et al.Simultaneous acute superior nerve neuronitis and benign paroxysmal positional vertigo[J].J Am Acad Audiol,2006,17:482.
2 Walther LE.Procedures for restoring vestibular disorderal[J].GMS Curr Top Otorhinolaryngol Head Neck Surg,2005,4:5.
3 Teggi R,Giordano L,Bondi S,et al.Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly [J].Eur Arch Otorhinolaryngol,2011,268:507.
4 Teggi R,Giordano L,Bondi S,et al.Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly[J].Eur Arch Otorhinolaryngol,2011,268:207.
5 刘晓薇,孙敬武,张波,等.良性阵发性位置性眩晕成功复位后残余头晕的危险因素分析[J].听力学及言语疾病杂志,2018,26:148.
6 Bhattaeharyya N,Reginald F,Baugh F,et al.Clinical practice guideline:Benign paroxysmal positional vertigo[J].Otolaryngology Head Neck Surg,2008,139(5 Suppl4):47.
7 Seok JI,Lee HM,Yoo JH,et al.Residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo[J].J Clin Neurol,2008,4:107.
8 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科学分会.良性阵发性位置性眩晕的诊断与治疗指南[J].中华耳鼻咽喉头颈外科杂志,2017,52:173.
9 张作记.行为医学量表手册[M].北京:中华医学电子音像出版社,2005.213～223.
10 Sharpley CF,Christh IE DR.Ananalys is of the psychometric Profile and frequency of anxiety and depression in Australian men with prostate cancer[J].Psychoon Cology,2007,16:660.
11 刘贤臣,唐茂芹,胡蕾,等.匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志,1996,29:103.
12 闫亚平,张淑香.特发性良性阵发性位置性眩晕发病危险因素研究进展[J].中国中西医结合耳鼻咽喉科杂志,2017,25:392.
13 Vrane?i■ Bender D,Giljevi■ Z,Ku?ec V,et al.Guidelines for the prevention,detection and therapy of vitamin D deficiency in adults[J].Lije■ Vjesn,2016,138:1.
14 Micarelli A,Viziano A,Alessandrini M.A comprehensive insight into the rehabilitative treatment of persistentbenign paroxysmal positional vertigo[J].J Int Adv Otol,2017,13:147.
15 Kim HA,Lee H.Autonomic dysfunction as a possible cause of residual dizziness after successful treatment in benign paroxysmal positional vertigo[J].Clinical Neurophysiology,2014,125:608.
16 Farally M,Lapenna R,Giommetti G,et al.Residual dizziness after the first BPPV episode:role of otolithic function and of a delayed diagnosis[J].Eur Arch Otorhinolaryngol,2016,273:3157.
17 Faralli M,Manzari L,Panichi R,et al.Subjective visual vertical before and after treatment of a BPPV episode[J].Auris Nasus Larynx,2011,38:307.
18 李斐,肖本杰,陈瑛,等.良性阵发性位置性眩晕复位后残余症状持续时间和病因分析[J].第二军医大学学报,2018,2:216.
19 胡进,傅伟达,尤克,等.继发性和原发性良性发作性位置性眩晕残余头晕症状的比较[J].中华全科医学,2017,10:1694.
20 D'Silva LJ,Staecker H,Lin J,et al.Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension[J].J Vestib Res,2016,25:233.
21 Martellucci S,Pagliuca G,de Vincentiis M,et al.Features of residual dizziness after canalith repositioning procedures for benign paroxysmal positional vertigo[J].Otolaryngology-Head and Neck Surgery,2016,154:693.
22 Chen ZJ,Chang CH,Hu LY,et al.Increased risk ofbenign paroxysmal positional vertigoin patients with anxiety disorders:a nationwide population-based retrospective cohort study[J].BMC Psychiatry,2016,16:238.
23 于新军,孙宝梅.良性阵发性位置性眩晕病因学研究[J].北京医学,2017,8:770.
24 岳伟,相蕾,张雅静,等.老年人良性阵发性位置性眩晕与颅内外血管病变的关系[J].中华老年医学杂志,2014,33:355.
25 De Stefano A,Dispenza F,Suarez H,et al.A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo[J].Auris Nasus Larynx,2014,41:31.
26 Celikbilek A,Gencer ZK,Saydam L,et al.Serum uric acid levels correlate with benign paroxysmal positional vertigo[J].Eur J Neurol,2014,21:79.
27 刘韵,王伟,龚树生.310例良性阵发性位置性眩晕患者发病相关因素分析[J].临床耳鼻咽喉头颈外科杂志,2016,9:748.
28 Sheikhzadeh M,Lotfi Y,Mousavi A,et al.Influence of supplemental Vitamin D on intensity of benign paroxysmal plsitional vertigo:a longitudinal clinical study[J].Caspian J Intern Med,2016,7:93.
29 Talaat HS,Kabel AM,Khaliel LH,et al.Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency[J].Auris Nasus Larynx,2016,43:237.
30 顾湘,董飞林,顾建华.良性阵发性位置性眩晕患者血清25羟维生素D水平研究[J].临床耳鼻咽喉头颈外科杂志,2017,31:924.
31 Maslovara S,Sollos B,Sestak A,et al.25(OH)D3 levels,in cideme and recurrence of different clinical forms of BPPV[J].Braz Otorhin Olarungol,2017,5:1.
32 贾永林,付志新,张宝华.良性发作性位置性眩晕手法复位后残余症状分析[J].中国实用神经疾病杂志,2017,20:12.
33 Gacek RR,Gacek MR.The three faces of vestibular ganglionitis[J].Ann Otol Rhinol Laryngol,2002,111:103.
34 Zapala DA,Shapiro SA,Lundy LB,et al.Simultaneous acute superior nerve neuronitis and benign paroxysmal positional vertigo[J].J Am Acad Audiol,2006,17:482.