常见前庭疾病患者水平半规管功能损害的发生状况及评价手段探讨  

The occurrence and evaluation methods of horizontal semicircular canal dysfunction in patients with common vestibular diseases

作　　者：田立娟 刘秀丽[1] 尹玉喜 王路阳[1] 韩威[1] TIAN Lijuan;LIU Xiuli;YIN Yuxi;WANG Luyang;HAN Wei(Department of Otorhinolaryngology Head and Neck Surgery,First Affiliated Hospital,Dalian Medical University,Dalian,116011,China;Department of Otorhinolaryngology Head and Neck Surgery,Yiyang City Center Hospital)

机构地区：[1]大连医科大学附属第一医院耳鼻咽喉头颈外科,辽宁大连116011 [2]益阳市中心医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2022年第9期670-674,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的了解常见前庭疾病患者水平半规管功能损害的发生状况,探讨不同水平半规管评价手段的特性及临床价值。方法回顾性分析2013年7月—2016年12月于大连医科大学附属第一医院眩晕专科门诊就诊且完成3种以上水平半规管功能检测,诊断为前庭性偏头痛(VM)、梅尼埃病(MD)、良性阵发性位置性眩晕(BPPV)、前庭神经炎(VN)的患者共396例及诊断不明患者104例,统计患者冷热试验(CT)、旋转试验(RT)、摇头眼震试验(HSN)及视频头脉冲试验(vHIT)的结果,计算不同检测手段的异常检出率,并以CT作为统计学的金标准评价各种检测手段的敏感性、特异性及符合率差异。结果①4种评价手段异常率由高至低依次为HSN、CT、RT、vHIT(51.20%、50.80%、25.76%、19.74%);②以CT作为金标准,在4种常见的前庭疾病中vHIT的敏感性为0.13~0.41、特异性为0.69~1.00,HSN的敏感性为0.44~0.76、特异性为0.29~0.69,RT的敏感性为0.25~0.45、特异性为0.50~0.84;③经统计学分析只有HSN与CT结果在4种疾病中差异无统计学意义,RT与CT在VM、BPPV中差异无统计学意义,而vHIT与CT结果只在BPPV中差异无统计学意义。结论常见前庭疾病中HSN结果异常率最高,建议作为常规前庭功能筛查项目;vHIT的特异性较高值得推广;CT仍为水平半规管功能评价不可替代的手段。Objective To understand the occurrence of horizontal semicircular canal functional impairment in patients with common vestibular diseases and to explore the characteristics and clinical value of different evaluation methods of horizontal semicircular canal.Methods From July 2013 to December 2016,patients who attended the vertigo clinic of the First Affiliated Hospital of Dalian Medical University and completed more than three horizontal semicircular canal function tests were retrospectively analyzed.A total of 396 patients diagnosed as vestibular migraine(VM),Ménière's disease(MD),benign paroxysmal positional vertigo(BPPV),vestibular neuritis(VN)and 104 patients with unknown diagnosis were enrolled.The results of caloric test(CT),rotation test(RT),head-shaking nystagmus test(HSN)and video head impulse test(vHIT)were collected and the abnormal detection rates of different detection methods were calculated.The sensitivity,specificity and coincidence rate of various detection methods were statistically analyzed using CT as the gold standard.Results①The abnormal rates of the four evaluation methods from high to low were HSN,CT,RT,vHIT(51.20%,50.80%,25.76%,19.74%,respectively);②Taking CT as the gold standard,among these four common vestibular diseases,the sensitivity and specificity of vHIT were 0.13-0.41 and 0.69-1.00,the sensitivity and specificity of HSN were 0.44-0.76 and 0.29-0.69,and the sensitivity and specificity of RT were 0.25-0.45 and 0.50-0.84;③According to statistical analysis,only HSN and CT results showed no statistically significant difference in the 4 diseases.There was no significant difference between RT and CT in VM and BPPV,and vHIT and CT in BPPV.Conclusion The abnormal rate of HSN results in common vestibular diseases is highest,and it could be recommended as a routine vestibular function screening item.The specificity of vHIT is highest and worthy of promotion.CT is still an irreplaceable method to evaluate the function of horizontal semicircular canal.

关 键 词：前庭疾病 水平半规管 冷热试验 旋转试验 摇头眼震 视频头脉冲试验 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]