眼震视图在多发性硬化和视神经脊髓炎中的应用  

Preliminary study on the application of videonystagmograph in Chinese patients with multiple sclerosis and neuromyelitis optica

作　　者：常艳宇 岑锦添[2] 张姝琪 王玉鸽[1] 戴永强[1] 陆正齐[1] 胡学强[1] 曾祥丽[2] 邱伟[1] 

机构地区：[1]中山大学附属第三医院神经病学科,广州510630 [2]中山大学附属第三医院耳鼻喉科

出　　处：《中国神经精神疾病杂志》2015年第10期596-600,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：中山大学高校基本业务费青年教师培育项目(编号:12ykpy36)

摘　　要：目的通过眼震视图(videonystagmograph,VNG)检查探讨多发性硬化(multiple sclerosis,MS)和视神经脊髓炎(neuromyelitis optica,NMO)眼球运动障碍的特点,以及VNG在MS和NMO的诊断与鉴别诊断中的价值。方法前瞻性入组16例MS、10例NMO患者及30例对照(突发性耳聋)进行VNG检查,对两组患者眼球运动障碍(扫视、凝视、平稳跟踪试验、视动眼震异常以及自发现眼震)阳性率等进行分析比较。结果 VNG检测发现MS组患者眼球运动障碍阳性率为68.75%,其中扫视异常、平稳跟踪试验异常及视动眼震异常出现均显著高于对照组(P分别为0.000、0.001、0.001);NMO组患者眼球运动障碍阳性率为80%,扫视异常、凝视异常、平稳跟踪试验异常及视动眼震异常出现显著高于对照组(P分别为0.000、0.012、0.000、0.002);而VNG检测MS和NMO患者眼球运动障碍出现率无统计学差异(68.50%vs.80.00%,P>0.05)。VNG检查眼球运动障碍的阳性率高于床边神经系统查体(68.75%vs.37.50%),并可能可以提示患者存在MRI不能分辨出的颅内病灶。结论小样本探索研究表明,VNG可以提高MS和NMO不同类型眼球运动障碍的检出率,对MS和NMO的颅内病灶的检测有一定的辅助价值,但在MS与NMO鉴别诊断中的意义有待进一步明确。Objective To investigate the characteristics of ocular movement disorders in patients with multiple sclerosis （MS） and neuromyelitis optica （NMO）, and explore the clinical application of videonystagmograph （VNG） exami- nation in the diagnosis and differential diagnosis of MS. Methods Sixteen MS ,10 NMO and 30 control （ sudden deafness ） patients were enrolled prospectively. Ocular movement disorders including saccades, gaze fixation, smooth pursuits, opto- kinetic nystagmus and spontaneous nystagmus were evaluated by using VNG. Results The positive rate of ocular motility disorders in MS patients detected by VGN was 68.75%. The incidences of abnormalities in saccades, smooth pursuits and optokinetic nystagmus were significantly higher in MS than in control groups （P= 0.000, 0.001 and 0.001, respectively）. The positive rate of ocular motility disorders in NMO patients detected by VGN was 80.00%. The incidences of abnormal- ities in saccades, gaze fixation, snmoth pursuits and optokinetic nystagmus were significantly higher in NMO than control groups （P= 0.000, 0.012, 0.000 and 0.002, respectively）. The positive rate of ocular motility disorders was not significant-ly different in MS and MS patients （68.5% vs. 80%, P〉0.05）. Compared with bedside physical examination, VNG showed a notable higher sensitivity in the detection of ocular motility disorders （68.75% vs. 37.50% ）. Furthermore, VNG disor- ders might indicate brain lesions undetected by MRI. Conclusion This small sample research indicates that VNG is a valuable tool in the detection of ocular motility disorders as well as brain lesions in MS and NMO patients. However, its role in the differential diagnosis between MS and NMO is not confirmed.

关 键 词：多发性硬化 眼震视图 视神经脊髓炎 

分 类 号：R744.5[医药卫生—神经病学与精神病学]