视频头脉冲检查在评价外周前庭病变中的作用  

Video head impulse test in peripheral vestibular diseases

作　　者：林颖[1] 高林溪 韩丽萍[1] 卢连军[1] 陈阳[1] 查定军[1] 邱建华[1] 

机构地区：[1]第四军医大学附属西京医院耳鼻咽喉头颈外科,西安710032

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第9期724-728,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：国家“十二五”科技支撑计划项目（2012BA112802）;国家自然科学基金青年项目（81100715）;西京医院学科助推计划（XJZT13R20）

摘　　要：目的 探讨视频头脉冲检查（video head impulse test,vHIT）在外周前庭病变患者前庭眼动反射功能评估中的临床价值.方法 25名无眩晕病史的健康自愿者作为对照组,男16例、女9例,年龄18 ～60岁.2014年4-5月在第四军医大学西京医院耳鼻咽喉头颈外科就诊的55例眩晕患者作为外周前庭病变组,根据病史及相关检查分别诊断为：前庭神经炎11例、突发性聋伴眩晕12例、前庭神经鞘瘤（听神经瘤）6例、梅尼埃病12例、双侧前庭功能低下15例.采用vHIT仪对受试者进行检查,利用软件记录补偿性扫视,计算瞬时增益（平均眼动和头动角速度比值）、眼动与头动速度回归方程的增益及不对称性.结果 健康对照组vHIT水平半规管40、60、80 ms的瞬时增益分别为0.88 ±0.17（均数±标准差,下同）、0.94±0.13、0.96±0.13.60 ms时左右侧眼动与头动速度回归方程的增益为0.99 ±0.11,不对称性为5.6±3.5.60 ms瞬时增益的正常范围为＞0.73,回归方程增益的正常范围为＞0.80.不同前庭疾病vHIT出现异常的比例依次为：前庭神经鞘瘤100％、前庭神经炎90.9％、双侧前庭功能低下86.7％、梅尼埃病40.0％、突发性聋伴眩晕38.5％.所有出现的补偿性扫视中,12.5％为孤立的隐性扫视（5/40）,45.0％为孤立的显性扫视（18/40）,42.5％为同时有隐性与显性扫视（17/40）.结论 vHIT操作简便,可通过增益值及扫视评估前庭眼反射功能,不同前庭疾病的阳性率差异较大.隐性扫视仅能通过vHIT发现,因此床旁头脉冲检查存在漏诊的风险.Objectives The function of the semicircular canal receptors and the pathway of the vestibulo-ocular reflex （VOR） can be diagnosed with the clinical head impulse test.The aim of the study was to investigate the horizontal VOR by means of video head impulse test in peripheral vestibular disorders.Methods Using the vHIT,we examined horizontal semicircular canal VOR in a group of 55 patients and a control group of 20 healthy subjects.The group of patients included 10 cases of vestibular neuritis （VN）,6 cases of vestibular schwannoma （VS）,12 cases of Meniere＇s disease （MD）,and 15 cases of bilateral vestibulopathy （BV）,as well as 13 cases of idiopathic sudden hearing loss with vertigo（ISHL）.Results Instantaneous gains of 40 ms,60 ms and 80 ms of horizontal VOR were 0.88 ± 0.17,0.94 ± 0.13 and 0.96 ±0.13,respectively.Regression gain at 60 ms was 0.99 ± 0.11,and asymmetry was 5.6 ± 3.5.Normal range of 60 ms instantaneous gain was 〉 0.73,normal range of regression gain was 〉 0.80.AbnormalvHIT was found in VS （100%）,VN （90.9%）,BV （86.7%）,MD （40.0%） and ISHL （38.5%）.Three conditions of refixation saccades occurred in cases with abnormal VOR：isolated covert saccades （12.5%）,isolated overt saccades （45.0%） and the combination of overt and covert saccades （42.5%）.Conclusions The vHIT detects abnormal VOR changes in the combination of gain assessment and refixation saccades.Since isolated covert saccades in VOR changes can only be seen with vHIT,peripheral vestibular disorders are likely to be misdiagnosed with the HIT.

关 键 词：前庭疾病 前庭功能试验 反射 前庭眼 眼扫视 半规管 

分 类 号：R764[医药卫生—耳鼻咽喉科]