听神经瘤患者前庭功能评估及临床价值  

Evaluation and clinical practice of vestibular function tests in acoustic neuroma

作　　者：郝维明 黄若男 赵卫东 万艺 李华伟 李文妍 HAO Weiming;HUANG Ruonan;ZHAO Weidong;WAN Yi;LI Huawei;LI Wenyan(Department of Otorhinolaryngology,Affiliated Eye and ENT Hospital,ENT Institute,Shanghai,200031,China;Department of Nursing,Affiliated Eye and ENT Hospital)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻喉科、耳鼻喉科研究院,上海200031 [2]复旦大学附属眼耳鼻喉科医院护理部

出　　处：《临床耳鼻咽喉头颈外科杂志》2022年第12期910-915,920,共7页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：复旦大学附属眼耳鼻喉科医院《促进市级医院临床技能与临床创新三年行动计划》(No:SHDC2022CRD006);复旦大学附属眼耳鼻喉科医院临床三年行动计划重大临床研究项目(No:SHDC2020CR3050B);上海市临床重点专科(No:shslczdzk00801)。

摘　　要：目的:通过对听神经瘤患者前庭功能进行多方面评估,探究不同前庭检测技术在前庭功能障碍诊断、代偿建立及肿瘤起源分析中的价值,为听神经瘤患者的前庭功能预后评价及康复策略提供借鉴。方法:回顾性分析2013年3月—2020年3月复旦大学附属眼耳鼻喉科医院耳鼻喉科收治的335例听神经瘤患者的多种术前前庭功能检查结果,包括温度试验、颈性前庭诱发肌源性电位(cVEMP)、眼性前庭诱发肌源性电位(oVEMP)、视频头脉冲试验(vHIT)及感觉统合试验(SOT),研究其在听神经瘤侧别判断中的灵敏度、特异度和约登指数等,分析各项检查的内部相关性,以及在肿瘤起源判断中的价值,并根据SOT结果对患者前庭代偿情况进行总结。结果:入组患者中温度试验、cVEMP、oVEMP、vHIT、SOT检查异常率依次为85.3%、86.1%、85.5%、55.6%和67.7%,其中温度试验表现出相对最优的灵敏度(0.855)、特异度(0.981)和约登指数(0.836)。相关性分析结果提示随听神经瘤Koos分级增加,温度试验、vHIT和oVEMP检查异常率也在增加(Cochran-Armitage趋势检验,P<0.05)。各项前庭功能检查异常与对应肿瘤来源神经之间未见显著相关性(P>0.05)。结论:多数听神经瘤患者术前存在前庭相关平衡障碍。超过50%的患者存在两项及以上前庭功能检查异常,提示前庭功能损伤范围较广。Koos分级越高,患者术前温度试验、vHIT和oVEMP检查异常率也更高。在判断患侧前庭功能异常方面,温度试验相对于cVEMP、oVEMP和vHIT检查显示出更佳的灵敏度与特异度。Objective:This study was conducted to evaluate the applications of vestibular function tests in diagnosis,identifying tumor origins and prognosis of vestibular rehabilitation of patients with acoustic neuroma.Methods:This research is a single-center cross-sectional clinical study,which retrospectively analyzed the data of 335 patients with acoustic neuroma from March 2013 to March 2020 in the Eye and ENT Hospital of Fudan University.The study included caloric test,cervical and ocular vestibular evoked myogenic potentials(cVEMP,oVEMP),video head impulse test(vHIT)and sensory organization test(SOT).Firstly,the sensitivity,specificity,and Yoden index of each test were calculated.Secondly,the internal relevance of these tests was studied for application in judging the origins of the tumor.Results:The abnormal rates of caloric test,cVEMP,oVEMP,vHIT and SOT was 85.3%,86.1%,85.5%,55.6%and 67.7%in these participants.Among all the vestibular function tests included,the caloric test showed the best sensitivity(0.855),specificity(0.981),and Yoden index(0.836).The study found that the higher the Koos grades,the higher the abnormal rates of the caloric test,vHIT,and oVEMP(Cochran-Armitage test,P<0.05).There was no significant relationship between the combination of abnormal vestibular function tests and tumor origin nerves(P>0.05).Conclusion:Majorlty of the participants in this study with acoustic neuroma showed abnormal results in SOT related to poor balance control.More than half of the patients had at least two abnormal result of the battery of vestibular function tests,among which the caloric test was proved to have better sensitivity and specificity.The higher the Koos grades of the tumor,the higher the abnormal rates of the caloric test,vHIT,and oVEMP.

关 键 词：听神经瘤 前庭功能检查 温度试验 

分 类 号：R764.4[医药卫生—耳鼻咽喉科]