梅尼埃病患者眼性前庭诱发肌源性电位频率调谐变化的研究  

Study on the shift of ocular vestibular evoked myogenic potentials frequency tuning of Meniere′s disease

作　　者：田永胜[1] 张秀菊[1] 马荣[1] 刘颖[1] 刘萍 张彦 郭良蓉[1] 王淑珍[1] 王丹[1] 段星 姚远 Tian Yongsheng;Zhang Xiuju;Ma Rong;Liu Ying;Liu Ping;Zhang Yan;Guo Liangrong;Wang Shuzhen;Wang Dan;Duan Xing;Yao Yuan(Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China)

机构地区：[1]航天中心医院耳鼻咽喉科,北京100049

出　　处：《中华耳鼻咽喉头颈外科杂志》2018年第12期904-908,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的通过分析单侧梅尼埃病患者不同频率气导短纯音诱发的眼性前庭诱发肌源性电位(oVEMP),探讨梅尼埃病oVEMP频率调谐变化的特点。方法研究对象为2016年5月至2017年10月33例在航天中心医院确诊为单侧梅尼埃病的患者,其中男11例、女22例,年龄35~65岁(中位年龄51岁)。同期20名健康人(40耳)作为对照,男7名、女13名,年龄29~68岁(中位年龄50岁)。分别以500Hz及1000Hz气导短纯音作为刺激声,对受试者进行oVEMP的检测。使用SPSS22.0统计软件对梅尼埃病患者患侧耳、对侧耳及健康组对照耳oVEMP的N1-P1波振幅及500/1000Hz频率振幅比进行比较分析,并对500/1000Hz频率振幅比进行受试者工作特征(receiver operating characteristic,ROC)曲线分析。结果500Hz的气导短纯音刺激下,梅尼埃病患者患耳、对侧耳以及健康受试者对照耳oVEMP的引出率分别为84.9%(28/33)、93.9%(31/33)和97.5%(39/40);1000Hz短纯音刺激下,患耳、对侧耳及对照耳oVEMP的引出率分别为81.8%(27/33)、87.9%(29/33)和82.5%(33/40)。500Hz短纯音刺激条件下,单侧梅尼埃病患者中患耳N1-P1波的振幅低于对侧耳及对照耳,与对照耳相比,差异有统计学意义(P<0.05),对侧耳N1-P1波的振幅小于对照耳,差异有统计学意义(P<0.05)。1000Hz短纯音刺激条件下,患侧耳及对侧耳与对照耳的N1-P1波振幅值组间比较,差异无统计学意义(P >0.05)。患侧耳500/1000Hz的频率振幅比明显小于对侧耳及对照耳(P<0.05)。频率调谐变化的频率振幅比临界值为1.17,在患耳中频率调谐变化的发生率为54.5%(18/33),显著高于对侧耳(18.2%,6/33,χ^2=9.429,P=0.002)和健康对照耳(7.5%,3/40,χ^2=19.530,P=0.000);对侧耳中也存在频率调谐变化,但与对照耳相比,差异无统计学意义(χ^2=1.909,P=0.167)。结论梅尼埃病患者oVEMP频率调谐特点发生了改变,表现出向高频区迁移的现象,oVEMP的频率振幅比可有助于梅尼埃病的病情评估。Objective To study the shift of oVEMP frequency tuning of unilateral Meniere′s disease, by analyzing oVEMP of air-conducted tone bursts in various frequencies. Methods From May 2016 to October 2017, 33 patients with unilateral Meniere′s from Aerospace Center Hospital were tested for oVEMP in 500 Hz and 1 000 Hz air-conducted tone bursts respectively, and 20 healthy subjects(40 ears), matched for age and sex, were used as healthy control. The amplitudes of the N1-P1 wave and the frequency amplitude ratios of 500/1 000 Hz in affected ears, unaffected ears and normal ears were compared;and receiver operating characteristic curve was analyzed for frequency amplitude ratios of 500/1 000 Hz. Results By the 500 Hz tone-burst stimulus, the provocation rates of the oVEMP were 84.9%(28/33), 93.9%(31/33) and 97.5%(39/40) in affected ears, contralateral ears and the ears of normal controls, respectively. By the stimulus of 1 000 Hz tone-burst, the provocation rates of the oVEMP were 81.8%(27/33), 87.9%(29/33) and 82.5% (33/40) in affected ears, contralateral ears and normal control ears, respectively. Amplitudes of N1-P1 waveforms in 500 Hz air-conducted tone bursts in affected ears were under normal control ears and contralateral ears. There was significant difference between affected ears and healthy control ears (P<0.05). Amplitudes of N1-P1 waveforms in contralateral ears were also significantly smaller than those in normal control ears (P<0.05). There were no significant differences in amplitudes of N1-P1 waveforms between affected ears, contralateral ears and normal control ears in 1 000 Hz tone bursts stimulus(P >0.05). Frequency amplitude ratios of 500/1 000 Hz in affected ears were significantly under contralateral and normal control ears (P<0.05). According to ROC, the frequency amplitude ratio critical value of frequency tuning was set as 1.17, the positive rate of frequency tuning shift in affected ears was 54.5%(18/33) and significantly higher than in contralateral ears(18.2%, 6/33, χ^2=9.429, P=0.002) and

关 键 词：梅尼埃病 前庭诱发肌源性电位 椭圆囊 频率调谐 

分 类 号：R764.33[医药卫生—耳鼻咽喉科]