前庭功能筛查的初步研究  

A Preliminary Study on Vestibular Function Screening

作　　者：杜一 刘兴健[1] 任丽丽[1] 张素珍[1] 吴子明[1] DU Yi;LIU Xingjian;REN Lili;ZHANG Suzhen;WU Ziming(Vertigo Clinic,Department of otolaryngology-Head and Neck Surgery,First Medical Center of Chinese PLA General Hospital)

机构地区：[1]解放军总医院第一医学中心耳鼻咽喉头颈外科眩晕诊疗中心

出　　处：《中华耳科学杂志》2022年第1期10-14,共5页Chinese Journal of Otology

摘　　要：目的面对日益增加的眩晕患者量,效率成为前庭功能检查选择的重要考量。本文的主要目的是评估自发眼震+变位试验+摇头试验(head shaking test,HST)+视频头脉冲检查(video head impulse test,vHIT)这种新的前庭速查方法作为前庭功能筛查的临床有效性。方法回顾性分析1282名于2020年3月至2021年3月到解放军总医院耳鼻咽喉头颈外科眩晕专科门诊就诊且有单独明确诊断的患者,整理其前庭功能检查结果,包括自发眼震、体位试验、HST、前庭双温检查和vHIT(增益和扫视波记为两个参数)。通过雷达图和树状图可视化检查异常率。结果通过比较不同功能检查异常率,可知vHIT增益值在不同疾病间异常率的变化不明显。新速查方法中vHIT的异常率仅考虑扫视波是否出现,新速查方法异常率整体优于前庭双温,主要表现为BPPV(100%vs.49%),VN(87%vs.76%),MD(81%vs.59%),VM(45%vs.36%)。通过优化分类的比较,新速查方法的异常率为72%,再进一步进行温度试验的结果(+/-)分别为35%与27%,而在新速查方法阴性筛查后再行双温试验的结果(+/-)分别为9%与16%。结论本文提出了一种临床适用前庭速查方法,即利用自发眼震+体位试验+HST+vHIT(扫视波)进行初步筛查。新速查方法比双温试验在各类疾病中的异常率更高,双温试验在眩晕患者初级诊疗的检查选择中不是必须选项。Objective With the number of vertigo patients trending up,the efficiency of vestibular function examination has become an important consideration for physicians.The main purpose of this study is to assess the effectiveness of a new fast vestibular screening protocol including spontaneous nystagmus(SN),positioning nystagmus(PN),head impulse test(HST)and video head impulse test(vHIT)in the clinic.Method Vestibular function test data from 1,282 patients who visited the vertigo clinic at the Chinese PLA General Hospital from March 2020 to March 2021 with a definite diagnosis were retrospectively analyzed,including SN,PN,HST,caloric test and vHIT(gain and saccades regarded as two separate parameters).Radar plot and Tree map were produced for data visualization.Results Except for vHIT gain,vestibular parameters varied among different disorders.When vHIT saccade,instead of gain,was used in the new fast screening protocol,its predicted rate of abnormality detection was higher than that of the caloric test,i.e.100%vs.49%for BPPV,87%vs.76%for vestibular neuritis,81%vs.59%for Meniere’s disease and 45%vs.36%for vestibular migraine.When positive by the new fast screening protocol(72%),rate of positive and negative caloric test was 35%and 27%,respectively,whereas the rate fell to 9%and 16%,respectively,when the new fast screening negative.Conclusion The new fast vestibular screening protocol proposed in this study,which includes SN,PN,HST and vHIT(saccades)is superior over caloric tests in vestibular disease detection,suggesting that the caloric test is not a mandatory choice in a primary care setting when considering vestibular function evaluation.

关 键 词：前庭功能筛查 头脉冲 扫视波 摇头眼震 前庭双温 

分 类 号：R764[医药卫生—耳鼻咽喉科]