视频眼震图与不同部位后循环梗死的相关性研究  

The correlation between videonystagmograph and posterior circulation infarction in different lesions

作　　者：刘昌晟 刘思 李声凯[2] 张荣[1] Changsheng;Liu Si;Li Shengkai;Zhang Rong(Department of Neurology,Hubei Aerospace Hospital,Xiaogan 432000,China)

机构地区：[1]湖北航天医院神经内科,湖北孝感432000 [2]湖北航天医院耳鼻喉科,湖北孝感432000

出　　处：《北京医学》2022年第8期675-681,共7页Beijing Medical Journal

基　　金：湖北省孝感市自然科学基金(XGKJ2020010092)

摘　　要：目的探讨视频眼震图(videonystagmograph,VNG)在不同后循环梗死(posterior circulation infarction,PCI)部位的结果特征及其相关性。方法选取2021年1—6月湖北航天医院以头晕为主诉住院的患者128例,其中46例PCI患者作为病例组,82例其他原因所致眩晕的非PCI患者作为对照组,通过视动系统和前庭系统检查,分析两组VNG检查结果的差异性,对不同病变部位与检查结果进行相关性分析。结果两组年龄、高血压、糖尿病及其他动脉粥样硬化危险因素比较,差异均有统计学意义(P<0.001)。病例组视动系统检查异常38例(82.6%),前庭系统检查异常18例(39.1%),对照组视动系统检查异常28例(34.1%),前庭系统检查异常71例(86.6%),两组比较差异均有统计学意义(P<0.001)。多因素logistic回归分析显示,年龄越大(OR=1.15,95%CI:1.03~1.28,P=0.01)、扫视精确度异常(OR=23.34,95%CI:3.04~179.00,P=0.00)、位置试验正常(OR=0.03,95%CI:0.00~0.60,P=0.02)的患者更容易诊断为PCI。倾向性匹配后,两组扫视精确度和位置试验比较,差异有统计学意义(P<0.001)。对检查项目和不同病变部位进行聚类分析,脑桥及小脑病变在眼震检查结果表现出较高类似度,丘脑与枕叶病变表现较高相似度,中脑与延髓病变各有其特点。结论VNG对于眩晕患者的PCI定位有一定的临床价值,结合患者体征能进一步提高对PCI诊断的准确性。Objective To investigate the characteristics and correlation of videonystagmograph(VNG)in different posterior circulation infarction(PCI)lesions.Methods One hundred and twenty-eight inpatients with dizziness were selected in Hubei Aerospace Hospital from January to June 2021.Case group included 46 PCI vertigo patients,and control group included 82 non-PCI vertigo patients.The differences of VNG results were analyzed by visual-vestibular reflexes system and vestibulo-ocular reflexes,correlation between different lesions and test results were analyzed.Results There were significant differences in age,hypertension,diabetes,and other atherosclerosis risk factors between the two groups(P<0.001).There were 38 cases(82.6%)with abnormal visual-vestibular reflexes and 18 cases(39.1%)with abnormal vestibulo-ocular reflexes in the case group,while there were 28 cases(34.1%)with abnormal visual-vestibular reflexes and 71 cases(86.6%)with abnormal vestibulo-ocular reflexes in the control group,there were significant differences in visual and vestibular system examination between the two groups(P<0.001).Multivariate logistic regression analysis showed that elder patients(OR=1.15,95%CI:1.03-1.28,P=0.01),abnormal results of accuracy saccade(OR=23.34,95%CI:3.04-179.00,P=0.00)and normal results of position test(OR=0.03,95%CI:0.00-0.60,P=0.02)were more likely to be diagnosed with PCI.There were statistically significant differences in the accuracy of saccade and position test between the two groups after propensity score matching(P<0.001).Cluster analysis of tests and different lesion sites showed that pons and cerebellum lesions had high similarity in VNG results,thalamus and occipital lobe lesions showed similarity,midbrain and medulla oblongata lesions had their own characteristics.Conclusions VNG has certain clinical value for the positioning diagnosis of vertigo patients,which can further improve the accuracy of etiologic diagnosis in PCI combined with signs.

关 键 词：后循环缺血 视频眼震图 眩晕 定位诊断 

分 类 号：R743.3[医药卫生—神经病学与精神病学]