头脉冲试验与头脉冲抑制试验参数相关性分析  

Correlation analysis of parameters between head impulse paradigm and suppression head impulse paradigm

作　　者：陈飞云 陈耔辰 魏馨雨 余津颖 张玉忠[1] 胡娟[1] 成颖[1] 吕旭霖 许信达 魏兰璎 任晓勇[1] 张青[1,5] CHEN Feiyun;CHEN Zichen;WEI Xinyu;YU Jinying;ZHANG Yuzhong;HU Juan;CHEN Ying;LYU Xulin;XU Xinda;WEI Lanying;REN Xiaoyong;ZHANG Qing(Department of Otorhinolaryngology Head and Neck Surgery,the Second Affiliated Hospital,Xi’an Jiaotong University,Xi’an 710004,China;Department of Otorhinolaryngology,First Hospital of Hanbin District,Ankang 725000,China;De partment of Otology and Skull Base Surgery,Eye Ear Nose and Throat Hospital,Fudan University,Shanghai Auditory Medical Center,Key Laboratory of Hearing Science,Ministry of Health,Shanghai 200031,China;Department of Anesthesiology,the Second Affiliated Hospital,Xi’an Jiaotong University,Xi’an 710004,China;Department of Otorhinolaryngology Head and Neck Surgery,Xinhua Hospital,ShangHai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]西安交通大学第二附属医院耳鼻咽喉头颈外科病院,陕西西安710004 [2]安康市汉滨区第一医院耳鼻咽喉科,陕西安康725000 [3]复旦大学附属眼耳鼻喉科医院耳神经颅底外科上海市听觉医学临床中心卫生部听觉医学重点实验室,上海200031 [4]西安交通大学第二附属医院麻醉科,陕西西安710004 [5]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科,上海200092

出　　处：《中国耳鼻咽喉颅底外科杂志》2020年第3期260-264,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：国家自然科学基金(81670945,81700915,81970891)。

摘　　要：目的验证头脉冲试验(HIMP)和头脉冲抑制试验(SHIMP)在前庭眼动反射中的互补效应。方法选择前庭上神经炎患者33例,健康成人10例(20耳),对前庭上神经炎患者患侧和健康成人左右侧HIMP和SHIMP增益、扫视潜伏期、扫视波振幅及显性扫视产生百分比进行匹配分析,比较HIMP和SHIMP各项参数之间相互关系。结果HIMP增益与SHIMP增益呈线性正相关,并且HIMP增益大于SHIMP增益,差异具有统计学意义(t=5.890,r=0.956,P均=0.000)。HIMP潜伏期大于SHIMP潜伏期,差异具有统计学意义(t=-3.360,P=0.001),但无相关性(r=0.180,P=0.196)。HIMP扫视振幅与SHIMP扫视振幅呈负相关(r=-0.484,P=0.000),HIMP扫视百分比与SHIMP显性扫视百分比呈负相关(r=-0.604,P=0.000)。HIMP增益与HIMP扫视潜伏期、振幅及百分比均呈负相关,且均具有统计学意义(P<0.05)。SHIMP增益与SHIMP代偿性扫视振幅及百分比呈正相关,具有统计学意义(P<0.05)。SHIMP增益与SHIMP扫视潜伏期无相关性(r=-0.044,P=0.756)。结论SHIMP和HIMP均可检查水平性角前庭眼动反射(VOR)的直接通路,代偿性扫视和反代偿性扫视的增益、振幅和扫视产生的百分比可作为动态观察指标评估前庭功能。两者参数变化对评估VOR通路的损伤和恢复情况起到一定指导意义。Objective To verify the complementary effect of head impulse paradigm(HIMP)and suppression head impulse paradigm(SHIMP)in vestibulo-ocular reflex.Methods Thirty-three patients with superior vestibular neuritis and 10 normal subjects(20 ears)were selected.Matching analyses on parameters including the gain of HIMP and SHIMP,latency and amplitude of saccades,and the percentage of saccades were made between the affected side of patients and the normal group to compare their relationships.Results There was a linear positive correlation between the HIMP gain and the SHIMP gain,the former was greater than the latter,and the difference was statistically significant(t=5.890,r=0.956,all P=0.000).The latency of HIMP was higher than that of SHIMP(t=-3.360,P=0.001),but there was no correlation(r=0.180,P=0.196).The saccades amplitude of HIMP was negatively correlated with that of SHIMP(r=-0.484,P=0.000),and the saccades percentage of HIMP was negatively correlated with that of SHIMP(r=-0.604,P=0.000).The gain of HIMP was negatively correlated with the saccades latency,amplitude and percentage of HIMP.The gain of SHIMP was positively correlated with the compensatory saccade amplitude and percentage of SHIMP(P<0.05).There was no correlation between the gain of SHIMP and the saccades latency of SHIMP(r=-0.044,P=0.756).Conclusion Both SHIMP and HIMP can be used to test the direct pathway of horizontal angular vestibulo-ocular reflex(aVOR).The gain,amplitude,and the percentage of saccades are dynamic indexes to evaluate vestibular function.Their parameter changes may have certain guiding significance to the evaluation of the damage and recovery of VOR pathway.

关 键 词：前庭功能 前庭上神经炎 头脉冲抑制试验 头脉冲试验 前庭眼动反射 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]