视频眼震电图联合头脉冲检查对急性前庭综合征病因性质的诊断价值  

Diagnostic value of video nystagmography combined with head impulse test in determining etiological nature of acute vestibular syndrome

作　　者：阿孜古丽·图尔逊江[1] 陈娟[1] 古丽波斯坦·买买提艾力[1] Aziguli TURXUNJIANG;CHEN Juan;Gulibositan MAIMAITIAILI(Center for Otolaryngology Diagnosis and Treatment,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi,Xinjiang,830001)

机构地区：[1]新疆维吾尔自治区人民医院耳鼻喉诊疗中心,新疆乌鲁木齐830001

出　　处：《实用临床医药杂志》2025年第8期40-44,51,共6页Journal of Clinical Medicine in Practice

基　　金：新疆少数民族科技人才特殊培养计划科研项目(2020D03010)。

摘　　要：目的探讨联合应用视频眼震电图和头脉冲检查(vHIT)对急性前庭综合征(AVS)患者病因性质的诊断价值。方法选取387例AVS患者为研究对象,并分为中枢组(中枢血管性,n=181)和外周组(前庭外周性,n=206)。分别采用视频眼震电图和vHIT对患者进行检查,并记录参数。结果视频眼震电图结果显示,中枢组平稳跟踪试验Ⅲ型曲线者、扫视试验欠冲者占比高于外周组,而位置性眼震和转椅旋转-急停试验眼震增益单侧减弱者占比低于外周组,差异有统计学意义(P<0.05)。中枢组vHIT异常者占比低于外周组,低频水平前庭眼动反射(VOR)增益值高于外周组,差异有统计学意义(P<0.05)。多因素Logistic回归显示,Ⅲ型曲线(OR=1.859,95%CI:1.235~3.032,P<0.001)和低频水平VOR增益值(OR=1.524,95%CI:1.102~2.231,P<0.001)与中枢血管性AVS相关,而vHIT异常(OR=0.523,95%CI:0.321~0.899,P<0.001)与前庭外周性AVS相关。受试者工作特征(ROC)曲线显示,Ⅲ型曲线、低频水平VOR增益值联合vHIT异常诊断中枢血管性与前庭外周性AVS的曲线下面积(AUC)为0.903(95%CI:0.812~0.956,P<0.001)。结论视频眼震电图联合vHIT是快速、准确鉴别AVS病因性质的重要工具。Objective To investigate the diagnostic value of combining video nystagmography and video head impulse test(vHIT)in determining the nature of acute vestibular syndrome(AVS).Methods A total of 387 patients with AVS were enrolled and divided into central group(central vascular,n=181)and peripheral group(vestibular peripheral,n=206).Patients underwent examinations using VOG and vHIT,and parameters were recorded.Results In video nystagmography results,the proportion of patients with typeⅢcurve in stable tracking test and recoil in saccade test in the central group was significantly higher,while the proportion of patients with unilateral weakening of nystagmus gain in positional nystagmus test and swivel chair rotation-scram test was significantly lower than that in the peripheral group(P<0.05).The proportion of vHIT abnormity in the central group was significantly lower,and the low-frequency level vestibular ocular reflex(VOR)gain values was significantly higher than that in the peripheral group(P<0.05).Multivariate logistic regression revealed that typeⅢcurves(OR=1.859,95%CI,1.235 to 3.032,P<0.001)and low-frequency level VOR gain values(OR=1.524,95%CI,1.102 to 2.231,P<0.001)were associated with central vascular AVS,whereas abnormal vHIT(OR=0.523,95%CI,0.321 to 0.899,P<0.001)was associated with vestibular peripheral AVS.Receiver operating characteristic(ROC)curve analysis indicated that the area under the curve(AUC)for diagnosing central vascular versus vestibular peripheral AVS using typeⅢcurves,low-frequency level VOR gain values and abnormal vHIT was 0.903(95%CI,0.812 to 0.956,P<0.001).Conclusion Combining video nystagmography with vHIT is an important tool for rapid and accurate differentiation of the etiology of AVS.

关 键 词：急性前庭综合征 视频眼震电图 头脉冲检查 平稳跟踪试验 前庭眼动反射 中枢血管性 前庭外周性 扫视试验 

分 类 号：R764[医药卫生—耳鼻咽喉科] R445[医药卫生—临床医学] R319