良性阵发性位置性眩晕复位后前庭诱发肌源性电位特征及其与复位后残余头晕的相关性研究  

Characteristics of Post-Repositioning Vestibular Evoked Myogenic Potentials and Their Correlation with Residual Dizziness in Benign Paroxysmal Positional Vertigo

作　　者：张睿琦 陈建勇[3] 蒋怀礼 张茹 张娜 赵艳丽 李华伟[1] 吴沛霞[1] ZHANG Ruiqi;CHEN Jianyong;JIANG Huaili;ZHANG Ru;ZHANG Na;ZHAO Yanli;LI Huawei;WU Peixia(Eye and ENT Hospital of Fudan University,Shanghai,200030,China;不详)

机构地区：[1]复旦大学附属眼耳鼻喉科医院,上海200030 [2]复旦大学护理学院 [3]上海交通大学医学院附属新华医院 [4]复旦大学附属中山医院 [5]同济大学附属东方医院

出　　处：《中华耳科学杂志》2025年第2期234-239,共6页Chinese Journal of Otology

基　　金：上海申康医院发展中心促进市级医院临床技能和临床创新三年行动计划(SHDC2022CRS003A);2022年复旦-复星护理科研基金(FNF202237)。

摘　　要：目的调查良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者在耳石复位后的前庭诱发肌源性电位(vestibular evoked myogenic potential,VEMP)表现,分析复位后有无残余症状患者的VEMP特征及其差异。方法回顾性分析2018年8月至2022年10月在复旦大学附属眼耳鼻喉科医院、上海交通大学医学院附属新华医院、复旦大学附属中山医院以及同济大学附属东方医院耳鼻喉科门诊连续入组的单侧后半规管或水平半规管BPPV患者198例。其中,男69例,女129例,平均年龄为(51.8±13.83)岁。在耳石复位成功后一周对患者进行随访,观察是否存在残余症状(头晕、眩晕、不稳感等),并对患者进行VEMP检查。结果198例患者中,水平半规管BPPV 56例,后半规管BPPV 142例,有93例患者(47%)报告存在复位后残余症状。残余症状组的眼性前庭诱发肌源性电位(ocular vestibular evoked myogenic potentials,oVEMP)引出异常率显著高于无残余症状组,差异有统计学意义(χ^(2)=5.08,P<0.05)。残余症状组BPPV患侧耳的P1潜伏期较无症状组延长(t=0.87,P<0.05),残余症状组的双侧未引出率均高于无残余症状组,患侧耳(χ^(2)=22.08,P<0.001),健侧耳(χ^(2)=16.80,P<0.001)。颈性前庭诱发肌源性电位(cervical vestibular-evoked myogenic potentials,cVEMP)的引出率两组间均无统计学差异,患侧耳(χ^(2)=1.30,P=0.254),健侧耳(χ^(2)=1.72,P=0.189)。BPPV患侧耳oVEMP阈值增高比例与健侧耳相比两组差异无统计学意义(χ^(2)=0.34,P=0.559)。但患侧耳cVEMP阈值增高比例显著高于健侧耳(χ^(2)=9.63,P<0.05)。结论耳石复位后存在残留症状的BPPV患者,其VEMP表现与无症状患者间存在显著差异,主要表现为存在残余症状的患者双侧耳oVEMP引出率均更低,oVEMP的异常率较cVEMP更高。Objective To report characteristics of post-repositioning vestibular evoked myogenic potentials(VEMPs)in patients with benign paroxysmal positional vertigo(BPPV)in comparison with patients without residual symptoms.Methods From August 2018 to October 2022,patients with unilateral posterior or horizontal semicircular canal BPPV were consecutively enrolled at the ENT outpatient departments of four hospitals in Shanghai.One week after successful otolith repositioning,patients were followed up for presence of residual symptoms(such as dizziness,vertigo or unsteadiness).VEMP characteristics were recorded and analyzed using the SPSS 26.0 statistical software.Results A total of 198 patients were enrolled,including 56 with horizontal semicircular canal BPPV and 142 with posterior semicircular canal BPPV.Among them,93(47%)reported residual symptoms after repositioning.The rate of abnormal oVEMPs was significantly higher in patients with residual symptoms compared to those with no residual symptoms(χ^(2)=5.08,P<0.05).Additionally,in patients with residual symptoms,P1 latency in the affected ear was longer than in those with no symptoms(t=0.87,P<0.05).The rate of bilateral oVEMP elicitation was lower in patients with residual symptoms than in those with no symptoms(affected earχ^(2)=22.08,P<0.001;unaffected earχ^(2)=16.80,P<0.001),although there was no significant difference in cVEMP elicitation between the two groups(affected earχ^(2)=1.3,P=0.254;unaffected earχ^(2)=1.72,P=0.189).There was no significant difference in the proportion of increased The rate of threshold elevation was more common in the affected ear than in the unaffected ear with cVEMPs(χ^(2)=9.63,P<0.05),but showed no significant difference with oVEMPs(χ^(2)=0.34,P=0.559).Conclusion BPPV patients with residual symptoms after otolith repositioning exhibited significant differences in VEMP responses compared to those without symptoms.These differences were primarily characterized by lower rates of bilateral oVEMP elicitation and a higher rate of abnorma

关 键 词：良性阵发性位置性眩晕 前庭诱发肌源性电位 残余症状 队列研究 

分 类 号：R764[医药卫生—耳鼻咽喉科]