前庭自旋转试验在椎-基底动脉供血不足性眩晕的应用研究  

Clinical research of vestibular autorotation test for patients with vertebrobasilar insufficiency

作　　者：陈太生[1] 王文红[2] 宋伟[1] 鲁宏华[1] 左宪华[2] 张金梅[1] 

机构地区：[1]天津市第一中心医院耳鼻咽喉科,300192 [2]天津市第一中心医院 神经内科,300192

出　　处：《中华耳鼻咽喉头颈外科杂志》2006年第10期721-725,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析前庭自旋转试验(vestibular autorotation test,VAT)在椎-基底动脉供血不足(vertebro-basilar insufficiency,VBI)性眩晕诊断中的临床价值。方法 VBI 性眩晕组73例,前庭周围性眩晕48例为对照组,应用 VAT 测试仪和视频眼震图(videonystagmography,VNG)仪,分别进行水平、垂直 VAT 测试和 VNG 各项眼动测试以及双耳交替冷热气试验。在 VAT 水平及垂直测试的增益和相位、水平非对称5项观测指标,以及 VNG 各项眼动测试和冷热气试验中,出现一项或一项以上异常即评定为该试验阳性。结果 VAT 测试:在 VBI 组以增益增高为特征,VBI 组和对照组增益增高分别为47例(64.4%)和5例(10.4%),差异有统计学意义(x^2=31.19,P<0.01);对照与 VBI 组增益减低分别为22例(45.8%)和11例(15.1%),差异有统计学意义(x^2=13.82,P<0.01);而相位、非对称以及 VAT 综合结果之间差异均无统计学意义。VBI 组 VNG 眼动系统测试异常结果高于前庭外周疾病患者,呈中枢性异常的表现,综合分析眼动系统系列检测和固视抑制试验各项指标,具有一项或一项以上结果异常者,VBI 患者44例(60.3%),前庭外周疾病患者10例(20.8%),差异有统计学意义(x^2=15.89,P<0.01);2组受试者冷热试验都存在高比例的单侧或双侧半规管轻瘫,差异无统计学意义。结论 VAT 在 VBI 性眩晕中以高增益为主要特征,而前庭周围性眩晕则以低增益为主。VAT 增益指标对于前庭系统损伤的定性评估能够提供有益的帮助,而相位和非对称指标可以判定前庭系统功能正常与否,但缺乏定性作用。Objective To explore the diagnostic values of vestibular autorotation test （VAT） for patients with vertebrobasilar insufficiency （VBI）. Methods VAT and videonystagmography （VNG） were performed on 73 patients with VBI and 48 patients with peripheral vestibular lesions （ contrast group）. Parameters analyzed included Gain, phase and asymmetry of VAT, as well as the canal parasis （CP） of caloric test and results of optokinetic-pursuit tests in VNG. Positive result of the test could be defined if anyone of the parameters was abnormal. Results For VAT test, Gain was enhanced in VBI group and was reduced in contrast group. In VBI group and contrast group, Gain enhanced showed in 47 （ 64.4% ） cases and 5 （ 10. 4% ） cases, respectively （ X^2 = 31.19, P 〈 0. 01 ）. Simultaneity, Gain reduced in 11 cases （15.5%） and 22 cases （45.8%）,respectively（X^2 = 13.82,P 〈0.01）.But there was no statistics significant for results of the parameters of phase, asymmetry and integration between two groups. For VNG test, results with optokinetic-pursuit tests were more abnormal in VBI group than that in contrast group, which showed central lesions characteristics. Forty-four cases （60.3%） in VBI group and 10 cases （ 20. 8% ） in control group showed central lesions results with optokinetic-pursuit tests and visual fixation test （ X^2 = 15.89 ,P 〈 0.01 ）. Unilateral or bilateral CP showed in 33 cases （ 68.6% ） in control group and 51 cases （69.9%） in VBI group with caloric test. Conclusions Gain of VAT is mostly enhanced in VBI group, and Gain as a main characteristic is reduced in patients with peripheral vestibular lesions. The Gain parameter is availability for assessing characteristics of vestibular lesions. Phase and asymmetry can be used to assess the vestibular function but can not indicate the characteristics of vestibular lesions.

关 键 词：前庭功能试验 椎底动脉供血不足 眩晕 

分 类 号：R743.3[医药卫生—神经病学与精神病学]