前庭功能检查在前庭神经炎急性期患者受损部位分析中的应用  

Application of vestibular function examination in the analysis of damaged site in patients with acute vestibular neuritis

作　　者：何风 韩军良 白雅 王圆圆 魏东 石瑛 安星月 付炜 HE Feng;HAN Junliang;BAI Ya;WANG Yuanyuan;WEI Dong;SHI Ying;AN Xingyue;FU Wei(Department of Neurology,Xijing Hospital,Fourth Military Medical University,Xi'an,710032,China;Department of Geriatrics,Xijing Hospital,Fourth Military Medical University)

机构地区：[1]空军军医大学第一附属医院神经内科,西安710032 [2]空军军医大学第一附属医院老年病科

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第4期263-267,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金(No:82202788);陕西省重点研发计划(No:2022SF-283);空军军医大学第一附属医院军事医学临床应用研究重点项目(No:JSYXM31)。

摘　　要：目的:通过对前庭神经炎急性期患者进行前庭功能检查,分析前庭神经受损的部位。方法:收集57例前庭神经炎急性期患者,每位患者进行双温试验、视频头脉冲试验(video head impulse test,vHIT)、前庭诱发肌源性电位(vestibular evoked myogenic potentials,VEMPs)检查,对所有患者的检查结果进行统计学分析。结果:双温试验异常率为92.98%,水平半规管vHIT异常率为92.98%,前半规管vHIT异常率为92.98%,后半规管vHIT异常率为52.63%,眼肌VEMPs(ocular vestibular evoked myogenic potentials,oVEMP)异常率为89.47%,颈肌VEMPs(cervical vestibular evoked myogenic potentials,cVEMP)异常率为52.63%;双温试验、水平与前半规管vHIT及oVEMP的异常率明显高于后半规管vHIT及cVEMP的异常率(P<0.01)。双温试验、水平、前及后半规管vHIT、oVEMP及cVEMP均异常即全前庭神经受损者26例(45.61%),双温试验、水平及前半规管vHIT、oVEMP均异常即前庭上神经受损者25例(43.86%),后半规管vHIT及cVEMP受损即前庭下神经受损者4例(7.02%),双温试验、水平及前半规管vHIT异常即末梢前庭神经受损者2例(3.51%);全前庭神经及前庭上神经受损率明显高于前庭下神经及末梢前庭神经受损率(P<0.01)。结论:前庭神经炎急性期亚型可分为四类:全前庭神经炎,前庭上神经炎,前庭下神经炎及末梢前庭神经炎。在对前庭神经炎急性期的患者进行亚型诊断时,vHIT能精确地评估前庭神经受损的部位,并且vHIT联合VEMPs能为末梢前庭神经炎的诊断提供客观依据。Objective: To analyze the site of vestibular nerve damaged in patients with acute vestibular neuritis.Methods: Fifty-seven patients with acute vestibular neuritis were recruited,and each patient underwent caloric irrigation test,video head impulse test(vHIT)and vestibular evoked myogenic potentials(VEMPs).The results were further analyzed.Results: Analysis of abnormal rates of different vestibular function tests:the abnormal rate of caloric irrigation test,horizontal semicircular canal vHIT,anterior semicircular canal vHIT,and posterior semicircular canal vHIT were 92.98%,92.98%,92.98%,and 52.63%,respectively.The abnormal rate of cervical vestibular evoked myogenic potentials(cVEMP)and ocular vestibular evoked myogenic potentials(oVEMP)were 52.63%and 89.47%.The abnormal rate of caloric irrigation test,horizontal semicircular canal vHIT,anterior semicircular canal vHIT,and oVEMP were significantly higher than posterior semicircular canal vHIT and cVEMP(P<0.01).Combination analysis of different vestibular function tests:there are twenty-six patients(45.61%,superior and inferior vestibular nerve)with abnormal caloric irrigation test,video head impulse test,and VEMPs.There are twenty-five patients(43.86%,superior vestibular nerve)with abnormal caloric irrigation test,horizontal semicircular canal vHIT,anterior semicircular canal vHIT,and oVEMP.There are 4 patients(7.02%,inferior vestibular nerve)with abnormal posterior semicircular canal vHIT and cVEMP.There are two patients(3.51%,ampullary vestibular nerve)with abnormal caloric irrigation test,horizontal semicircular canal vHIT,and anterior semicircular canal vHIT.The rate of superior and inferior vestibular neuritis and superior vestibular neuritis were significantly higher than inferior vestibular neuritis and ampullary vestibular neuritis(P<0.01).Conclusion: Acute vestibular neuritis subtypes can be divided into four categories:superior and inferior vestibular neuritis,superior vestibular neuritis,inferior vestibular neuritis,and ampullary vestibular neuritis.Vid

关 键 词：前庭神经炎 视频头脉冲试验 双温试验 前庭诱发肌源性电位 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]