视频头脉冲试验鉴别前庭神经炎和后循环卒中导致急性前庭综合征的临床应用价值  

Clinical application value of video head impulse test in identifying acute vestibular syndrome caused by vestibular neuritis from that caused by posterior circulation stroke

作　　者：芮汉臣[1] 张丽华[1] 李广从 王立敏 李倩[1] 杨潮萍[1] RUI Hanchen;ZHANG Lihua;LI Guangcong(Department of Neurology,Cangzhou Central Hospital,Cangzhou 061000,CHINA)

机构地区：[1]沧州市中心医院神经内科,河北061000

出　　处：《江苏医药》2024年第1期34-38,共5页Jiangsu Medical Journal

基　　金：河北省医学跟踪适用技术跟踪项目(GZ2020014)。

摘　　要：目的 探讨视频头脉冲试验(vHIT)在鉴别前庭神经炎(VN)和后循环卒中(PCS)导致急性前庭综合征(AVS)中的临床诊断价值。方法 回顾性分析37例VN导致AVS患者(VN组)和41例PCS导致AVS患者(PCS组)的临床资料。两组患者均于发病7 d内完成vHIT检查,并绘制ROC曲线分析vHIT各参数对VN和PCS的鉴别诊断价值。结果 VN组患者年龄、患侧VOR增益值、潜伏期以及男性、高同型半胱氨酸血症、既往脑卒中或短暂性脑缺血发作史比例低于PCS组,而增益不对称比、患侧扫视频率、峰速度、幅度和累积幅度高于PCS组(P<0.05)。患侧VOR增益值、增益不对称比、患侧扫视频率和峰速度诊断VN的AUC分别为0.905、0.902、0.790和0.849(P<0.05);当患侧VOR增益值取最佳诊断界值为0.71时,其对应的灵敏度为83.78%,特异度为90.24%。当患侧VOR增益值≤0.71分别联合增益不对称比≥10.24%、患侧补偿性扫视频率≥137%、患侧峰速度≥122.5度/秒诊断VN时,其灵敏度为94.59%、91.89%、91.89%,特异度为80.49%、90.24%、90.24%。结论 vHIT检查可用于鉴别诊断VN与PCS,VOR增益值、增益不对称比和补偿性扫视频率或峰速度等参数能提高鉴别VN与PCS导致AVS的准确性。Objective To investigate the clinical diagnostic value of video head impulse test(vHIT) in identifying the acute vestibular syndrome(AVS) caused by vestibular neuritis(VN) and that caused by posterior circulation stroke(PCS).Methods The clinical data of 37 patients with VN-caused AVS(group VN) and 41 patients with PCS-caused AVS(group AVS) were retrospectively analyzed.All the patients were assessed by horizontal vHIT within 7 days of onset.The diagnostic value of vHIT indexes in identifying VN and PCS was analyzed by ROC curve.ResultsThe age, vestibulo-ocular reflex(VOR) gain of affected side, onset latency and the percentages of male patients, and the patients with hyperhomocysteinemia and history of stroke and transient ischemic attack in group VN were lower than those in group PCS,while the ratio of gain asymmetry, compensatory saccade frequency, peak velocity, amplitude and accumulated amplitude were higher in group VN than those in group PCS(P<0.05).The AUC values of VOR gain of affected side, ratio of gain asymmetry, compensatory saccade frequency and peak velocity of affected side in the diagnosis of VN were 0.905,0.902,0.790 and 0.849,respectively(P<0.05).Taking VOR gain of affected side 0.71 as the cut-off value, the corresponding sensitivity and specificity were 83.78% and 90.24%.When VOR gain of affected side ≤ 0.71 combined with the ratio of gain asymmetry ≥ 10.24%,compensatory saccade frequency of affected side ≥ 137% and peak velocity of affected side ≥ 122.5 degree/second in the the diagnosis of VN,the values of sensitivity were 94.59%,91.89% and 91.89%,and the values of specificity were 80.49%,90.24% and 90.24%,respectively.ConclusionvHIT can be used in the differential diagnosis of VN and PCS.VOR gain, ratio of gain asymmetry and compensatory saccade frequency or peak velocity can improve the accuracy of identifying AVS caused by VN and PCS.

关 键 词：急性前庭综合征 视频头脉冲试验 后循环卒中 前庭神经炎 

分 类 号：R747[医药卫生—神经病学与精神病学]