前庭功能自旋试验和经颅多普勒超声对中枢性眩晕的应用价值  

The value of VAT and TCD in diagnosis of patients with central vertigo

作　　者：陈钜涛[1] 李婷婷[1] 谷艳霞[1] 张峥[1] 王超[1] 刘欢[1] 张兆辉[1] 

机构地区：[1]武汉大学人民医院神经内科,430060

出　　处：《卒中与神经疾病》2016年第2期94-97,共4页Stroke and Nervous Diseases

摘　　要：目的探讨前庭自旋试验(vestibular autorotation text,VAT)、经颅多谱勒超声(TCD)在中枢性眩晕诊断中的临床应用价值。方法对86例中枢性眩晕患者和对照组(周围性眩晕患者68例、健康志愿者36例)进行VAT和TCD检测,计算检查两种方法完成率和敏感性等指标;比较中枢性眩晕组和对照组VAT、TCD参数水平的差异。结果190例研究对象TCD完成率(100%)高于VAT完成率91.6%(P<0.05);中枢性眩晕组、周围性眩晕组、健康对照组VAT完成率分别为93%、88.2%、94.4%(P>0.05)。完成2个检测方法的174例研究对象,中枢性眩晕组水平增益增高高于其他组(P<0.05);周围性眩晕水平增益降低高于其他组(P<0.05);周围性眩晕组中非对称性异常高于其他组(P<0.05);三组间的水平相移、垂直相移、垂直增益无明显差异(P>0.05);VAT法对中枢性眩晕的敏感性、特异性、阳性拟然比、阴性拟然比分别为85%、94.7%、12.41、0.16;TCD法分别为52.5%、89.4%、2.73、0.53;2种方法联合为92.5%、86.2%、6.19、0.09。结论 VAT和TCD对诊断中枢性眩晕的价值各有优劣,VAT比TCD更灵敏、准确,而TCD法更简便,检查完成率更高,2种方法联合时诊断的敏感性增加,提高了中枢性眩晕的诊断水平。Objective To investigate the diagnostic value of VAT and TCD in patients with central vertigo.Methods VAT and TCD were performed on 88 central vertigo patients of department of Neurology and controls（70 peripheral vertigo patients and 38 healthy controls）.The rate of test completion was calculated respectively.The difference of parameters of VAT and TCD were analyzed and compared between central vertigo patients and controls.Furthermore,we calculated and compared their sensitivity,specificity,positive likelihood ratio and negative likelihood ratio.Results The rate of completion of TCD（100%）was higher than VAT（89%）（P〈0.05）;In the central vertigo group,peripheral vertigo group and healthy group,the rate of VAT completion were 90.9%、84.5%、91.9%,respectively（P〉0.05）.The increased horizontal gains in the central vestibular group were significantly higher than those of other groups（P〈0.05）.The decreased horizontal gains in the peripheral vestibular group were significantly higher than those of other groups（P〈0.05）.The abnormal asymmetry in the peripheral vestibular group were significantly higher than those of other groups（P〈0.05）.But there was no statistical significant difference in the results of the other parameters among the three groups.Sensitivity,specificity,positive likelihood ratio and negative likelihood ratio of VAT to diagnose central vertigo were as follow ：85%,94.7%,12.41,0.16;Sensitivity,specificity,positive likelihood ratio and negative likelihood ratio of TCD were 52.5%,89.4%,2.73,0.5,respectively.Combined method＇s were 92.5%,86.2%,6.19,0.09.Conclusion VAT and TCD have their own merits and defects in diagnosing central vertigo.VAT is more sensitive and accurate.TCD is more convenient and has higher rate of completion.Combined method owns higher sensitivity and lower negative likelihood ratio,which raises the diagnostic value of central vertigo.

关 键 词：中枢性眩晕 外周性眩晕 前庭功能自旋试验(VAT) 经颅多普勒(TCD) 

分 类 号：R745.1[医药卫生—神经病学与精神病学]