原发性良性阵发性位置性眩晕患者VEMP异常率的临床观察  

Abnormality rate of vestibular evoked myogenic potentials in patients with primary and recurrent benign paroxysmal positional vertigo: a clinical observation

作　　者：陈建勇[1] 孙夏雨 沈佳丽 汪玮[1] 王璐[1] 贺宽 张勤[1] 马孝宝 沈敏 陈向平 杨军[1] CHEN Jianyong;SUN Xiayu;SHEN Jiali;WANG Wei;WANG Lu;HE Kuan;ZHANG Qin;MA Xiaobao;SHEN Min;CHEN Xiangping;YANG Jun(Department of Otolaryngology&Head and Neck Surgery,Xinhua Hospital,Shanghai Jiaotong University School of Medicine/Ear Institute,Shanghai Jiaotong University School of Medicine/Shanghai Key Laboratory of Translational Medicine on Ear and Nose Disease,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科/上海交通大学医学院耳科学研究所/上海市耳鼻疾病转化医学重点实验室,上海200092

出　　处：《山东大学耳鼻喉眼学报》2020年第5期51-55,共5页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：上海交通大学医工交叉重点项目(ZH2018ZDA11);上海交通大学医学院附属新华医院院级临床研究培育基金项目(17CSK03,18JXO04)

摘　　要：目的比较原发性初发和复发良性阵发性位置性眩晕(BPPV)患者的前庭诱发肌源性电位(VEMPs)特点,探索原发性BPPV屡次复发的可能发病机制。方法收集首次就诊即确诊为单侧原发性BPPV的患者57例,其中初发患者36例,复发患者21例。所有患者均进行气导声刺激条件下的颈肌VEMP(cVEMP)和眼肌VEMP(oVEMP)检查,对比分析初发组和复发组cVEMP和oVEMP结果的差异。结果(1)初发和复发BPPV组在性别、发病侧别及受累半规管均无统计学差异(P>0.05),年龄存在统计学差异(P<0.05);(2)57例BPPV患者中21例(36.84%)cVEMP异常,35例(61.40%)oVEMP异常,oVEMP异常率更高(P<0.05);分别对初发组中和复发组中的cVEMP和oVEMP异常率进行比较,结果显示两组oVEMP异常率更高,差异具有统计学意义(P<0.05);(3)初发BPPV组cVEMP异常有16例(44.45%),复发BPPV组异常有5例(23.81%);初发BPPV组oVEM异常有19例(52.79%),复发BPPV组中oVEMP异常有16例(76.19%);两组cVEMP和oVEMP异常率均无统计学差异(P>0.05);(4)复发2次组和复发3次以上组,与初发组进行VEMPs异常率比较显示三组间cVEMP及oVEMP异常率均无统计学差异(P>0.05)。结论原发性初发组和复发组BPPV患者的cVEMP和oVEMP异常率差异均无统计学意义,提示耳石器功能异常可能不是原发性BPPV患者反复复发的发病机制。Objective This study aimed to compare the abnormality rate of vestibular evoked myogenic potentials(VEMPs)in patients with primary and recurrent benign paroxysmal positional vertigo(BPPV)and test the hypothesis that otolith dysfunction causes the recurrence of BPPV.Methods Cervical VEMP(cVEMP)and ocular VEMP(oVEMP)tests using air-conducted 500 Hz tone-burst stimuli were performed on 57 patients with unilateral primary BPPV(n=36)and recurrent BPPV(n=21)between June 2019 and May 2020.Abnormalities in cVEMP and oVEMP were compared between the primary and recurrent BPPV groups.Results(1)The differences in sex,the involved side,and canal between the primary and recurrent BPPV groups were not significant;however,the difference was statistically significant in terms of age;(2)Of the 57 BPPV patients,cVEMP or oVEMP was not elicited in 21 cases(36.84%)and 35 cases(61.40%),respectively.The abnormality rate of oVEMP was much higher(P<0.05);(3)Abnormal cVEMP was observed in 16 of 36(44.45%)and 5 of 21(23.81%)cases in the primary and recurrent BPPV groups,respectively.Abnormal oVMEP was observed in 19 of 36(52.79%)and 16 in 21(76.19%)patients in the primary and recurrent BPPV groups,respectively.Differences in the abnormality rates of cVMEP and oVMEP were not found between the primary and recurrent BPPV groups(P>0.05);(4)When the recurrent BPPV group was further divided into 2-times groups and≥3-times group according to the recurrent frequency,there were also no statistical differences in the VEMP abnormality rate in these three groups(P>0.05).Conclusion The results showed no significant difference in the abnormality rate of cVEMP and oVEMP between the primary BPPV and recurrent BPPV groups,indicating that the possible recurrent mechanism of primary BPPV still needs to be further studied.

关 键 词：良性阵发性位置性眩晕 颈肌前庭诱发肌源性电位 眼肌前庭诱发肌源性电位 初发性 复发性 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]