前庭自旋转实验非对称性异常对眩晕性疾病临床诊断意义分析
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摘要
目的探讨前庭自旋转试验(vestibular autorotation test,VAT)非对称性异常的临床意义。方法纳入眩晕或头晕症状且VAT显示非对称异常的患者,按照VAT水平增益值分为非对称异常合并水平增益降低组,非对称异常合并水平增益增高组和非对称异常合并水平增益正常组。比较3组疾病构成情况。结果研究共纳入108例患者,其中非对称异常合并水平增益降低组56例,其中45例(80.4%)为前庭外周性疾病,11例(19.6%)为前庭中枢性疾病;非对称异常合并水平增益增高组35例,均为前庭中枢性疾病(100%);非对称异常合并水平增益正常组17例,15例(88.2%)为前庭外周性疾病,2例(11.8%)为前庭中枢性疾病。3组间疾病构成有显著差异。其中非对称异常合并水平增益增高组的前庭中枢性疾病发病率显著高于非对称异常合并水平增益降低组和非对称异常合并水平增益正常组(均P<0.001)。结论 VAT非对称性异常多提示前庭外周性疾病,但非对称性异常合并水平增益增高提示前庭中枢性疾病可能。
Objective To investigate the clinical significance of asymmetry results from vestibular autorotation test(VAT). Methods All patients were divided into 3 groups by horizontal gain: abnormal asymmetry and decreased horizontal gain group(Group A),abnormal asymmetry and increased horizontal gain(Group B),and abnormal asymmetry and normal horizontal gain(Group C). Then the disease constitution of the 3 groups were compared.Results Group A(n=56) had 45 patients(80.4%) of peripheral vestibular diseases and 11 patients(19.6%) of central vestibular diseases. All the patients(100%) in group B(n =35) had central vestibular diseases. Group C(n =17) had 15 patients(88.2%) of peripheral vestibular diseases and 2 patients(11.8%) of central vestibular diseases. The incidence rates of central vestibular disease in Group B were significantly higher than those in Groups A and C(P<0.001). Conclusion The abnormal asymmetry mostly indicated peripheral vestibular diseases,however,the abnormal asymmetry with increased horizontal gain suggested the possibility of central vestibular diseases.
Objective To investigate the clinical significance of asymmetry results from vestibular autorotation test(VAT). Methods All patients were divided into 3 groups by horizontal gain: abnormal asymmetry and decreased horizontal gain group(Group A),abnormal asymmetry and increased horizontal gain(Group B),and abnormal asymmetry and normal horizontal gain(Group C). Then the disease constitution of the 3 groups were compared.Results Group A(n=56) had 45 patients(80.4%) of peripheral vestibular diseases and 11 patients(19.6%) of central vestibular diseases. All the patients(100%) in group B(n =35) had central vestibular diseases. Group C(n =17) had 15 patients(88.2%) of peripheral vestibular diseases and 2 patients(11.8%) of central vestibular diseases. The incidence rates of central vestibular disease in Group B were significantly higher than those in Groups A and C(P<0.001). Conclusion The abnormal asymmetry mostly indicated peripheral vestibular diseases,however,the abnormal asymmetry with increased horizontal gain suggested the possibility of central vestibular diseases.
引文
[1]THUNGAVELU Y,WANG W,LIN P,et al.The clinical utility of vestibular autorotation test in patients with vestibular migraine[J].Acta Otolaryngol,2017,130(10):1046-1050.
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[4]中华医学会神经病学分会.中华神经科杂志编辑委员会.眩晕诊治的专家共识[J].中华神经科杂志,2010,43(5):369-374.
[5]BLATT P J,SCHUBERT M C,ROACH K E,et al.The reliability of the Vestibular Autorotation Test(VAT)in patients with dizziness[J].Neurol Phys Ther,2008,32(2):70-79.
[6]PARK H K,KIM J S,STRUPPM,et al.Isolated floccular infarction:impaired vestibular responses to horizontal head impulse[J].Neurol,2013,260(6):1576-1582.
[7]HSIEH L C,LIN T M,CHANG Y M,et al.Clinical applications of correlational vestibular autorotation test[J].Acta Otolaryngol,2015,135(6):549-556.
[8]LEE H.Isolated vascular vertigo[J].Stroke,2014,16(3):124-130.
[9]INOUE Y,YABE T,OKADA K,et al.Effect of edaravone on acute brainstem cerebellar infarction with vertigo and sudden hearing loss[J].Auris Nasus Larynx,2014,41(3):303-306.
[10]CHOI S Y,KIM H J,KIM J S.Chasing dizzy chimera:Diagnosis of combined peripheral and central vestibulopathy[J].Neurol S,2016,371(12):69-78.
[11]CHO B H,KIM S H,KIM S S,et al.Central positional nystagmus associated with cerebellar tumors:Clinical and topographical analysis[J].Neurol Sci,2017,373(2):147-151.
[2]田军茹.眩晕诊治[M].北京:人民卫生出版社,2015:16-20.
[3]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.梅尼埃病的诊断依据和疗评估[J].中华耳鼻咽喉头颈外科杂志,2007,42(3):163.
[4]中华医学会神经病学分会.中华神经科杂志编辑委员会.眩晕诊治的专家共识[J].中华神经科杂志,2010,43(5):369-374.
[5]BLATT P J,SCHUBERT M C,ROACH K E,et al.The reliability of the Vestibular Autorotation Test(VAT)in patients with dizziness[J].Neurol Phys Ther,2008,32(2):70-79.
[6]PARK H K,KIM J S,STRUPPM,et al.Isolated floccular infarction:impaired vestibular responses to horizontal head impulse[J].Neurol,2013,260(6):1576-1582.
[7]HSIEH L C,LIN T M,CHANG Y M,et al.Clinical applications of correlational vestibular autorotation test[J].Acta Otolaryngol,2015,135(6):549-556.
[8]LEE H.Isolated vascular vertigo[J].Stroke,2014,16(3):124-130.
[9]INOUE Y,YABE T,OKADA K,et al.Effect of edaravone on acute brainstem cerebellar infarction with vertigo and sudden hearing loss[J].Auris Nasus Larynx,2014,41(3):303-306.
[10]CHOI S Y,KIM H J,KIM J S.Chasing dizzy chimera:Diagnosis of combined peripheral and central vestibulopathy[J].Neurol S,2016,371(12):69-78.
[11]CHO B H,KIM S H,KIM S S,et al.Central positional nystagmus associated with cerebellar tumors:Clinical and topographical analysis[J].Neurol Sci,2017,373(2):147-151.