前庭性偏头痛与前庭神经炎患者的变温试验及视频头脉冲试验结果差异分析  

Analysis of the difference between the results of caloric tests and video head pulse tests in patients with vestibular migraine and vestibular neuritis

作　　者：王雯 杨月嫦[2] 庄建华[2] 李斐[2] 高博 WANG Wen;YANG Yuechang;ZHUANG Jianhua;LI Fei;GAO Bo(Department of Neurology ,Jingan District Zhabei Central Hospital, Shanghai, 200070, China;Department of Neurology, Changzheng Hospital, Second Military Medical University)

机构地区：[1]上海市静安区闸北中心医院神经内科,上海200070 [2]第二军医大学长征医院神经内科

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第9期647-652,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:比较前庭性偏头痛(VM)与前庭神经炎(VN)患者的变温试验及视频头脉冲试验(VHIT)结果,为二者的鉴别诊断提供帮助。方法:回顾性分析2016-08-01-2017-12-31期间第二军医大学长征医院神经内科门诊就诊的发病2周内的VM和VN患者,所有患者行变温试验及VHIT,并对2组的检查结果进行比较分析。结果:40例VM患者中,23例变温试验异常,17例为单侧半规管轻瘫,6例为双侧半规管反应低下,单侧异常率高于双侧异常(χ~2=7.384,P=0.007);8例VHIT异常,3例为单侧前庭眼反射(VOR)增益下降,5例为双侧VOR增益下降,单、双侧VHIT异常率差异无统计学意义(P=0.619)。45例VN患者中,45例变温试验异常,37例为单侧半规管轻瘫,8例为双侧半规管反应低下,单侧异常率高于双侧异常(χ~2=37.378,P<0.001);35例VHIT异常,21例为单侧VOR增益下降,14例为双侧VOR增益下降,单、双侧VHIT异常率差异无统计学意义(χ~2=2.800,P=0.094)。经统计分析,VN、VM的变温异常率均高于VHIT(P=0.001),且VM患者的变温及VHIT异常率均低于VN(P<0.001)。VM患者变温试验反应强、弱两侧的慢相角速度以及3组半规管VHIT增益值均高于VN患者的相应管(P<0.05)。结论:VN和VM患者半规管前庭功能的低频损伤均多于高频。与VM比较,VN患者半规管的高、低频损伤更多见,并易出现高低频同时受累,VN患者半规管的高低频前庭功能受损程度较VM患者更严重。Objective：To compare the results of caloric tests and video head impulse tests（VHIT）in patients with vestibular migraine（VM）and vestibular neuritis（VN）,so as to provide help for the differential diagnosis of the two patients.Method：Retrospectively analyze VM and VN patients within 2 weeks of onset from August 1,2016 to December 31,2017 in neurology clinic of the Changzheng Hospital of Second Military Medical University,all patients were examined by caloric tests and VHIT,and the results of the two groups were compared and analyzed.Result：The 40 cases of VM patients,among them,23 cases were abnormal in caloric test,17 cases showed unilateral canal paresis,6 cases showed bilateral weakness,the unilateral abnormality rate was higher than that of bilateral abnormality（χ^2=7.384,P=0.007）.Eight cases were abnormal in VHIT,3 cases had unilateral vestibulo-ocular reflex（VOR）gain decline,5 cases had bilateral VOR gain decline,unilateral and bilateral VHIT abnormal rate had no difference（P=0.619）.The 45 cases of VN patients,among them,45 cases were abnormal in caloric test,37 cases showed unilateral canal paresis,8 cases showed bilateral weakness,the unilateral abnormality rate was higher than that of bilateral abnormality（χ^2=37.378,P〈0.001）.Thirty-five cases were abnormal in VHIT,21 cases had unilateral VOR gain decline,14 cases had bilateral VOR gain decline,unilateral and bilateral VHIT abnormal rate had no difference（χ^2=2.800,P=0.094）.By statistical analysis,the abnormal rate of caloric test of VN and VM were higher than that of VHIT,and the abnormal rate of caloric test and VHIT in VM patients were lower than that of VN.The slow phase velocity（SPV）and the VHIT gain of the three group of semicircular canals of strong and weak caloric response sides in the VM patients were higher than those of the corresponding canals in the VN patients.Conclusion：The low frequency damage of vestibule function of semicircular canals in VN and VM patients is more than that of high freque

关 键 词：前庭性偏头痛 前庭神经炎 变温试验 视频头脉冲试验 慢相角速度 半规管 前庭眼反射 增益 

分 类 号：R441.2[医药卫生—诊断学]