快速轴位滚转试验在水平半规管良性阵发性位置性眩晕患侧诊断中的临床价值

Clinical value of rapid axial roll test in diagnosis of the affected side of horizontal semicircular canal benign paroxysmal positional vertigo

目的探讨传统滚转试验(supine roll test,SRT)、低头-抬头试验(bow and lean test,BLT)和快速轴位滚转试验(rapid axial roll test,RART)在水平半规管良性阵发性位置性眩晕(horizontal semicircular canal benign paroxysmal positional vertigo,HSC-BPPV)责任半规管判定中的临床价值。方法选取2021年3月至2022年4月西安交通大学第一附属医院HSC-BPPV患者328例,根据不同的变位试验分为SRT组(113例)、BLT+SRT组(104例)和RART+SRT组(111例),BLT+SRT组和RART+SRT组分为2个阶段,第一阶段进行BLT或RART,第二阶段进行SRT。比较不同组别眼震引出率,采用Kappa一致性检验比较BLT/RART与SRT眼震引出结果的一致性。结果328例患者中,男95例,女233例,年龄18~86岁,平均(55.5±13.8)岁。RART+SRT组眼震引出率高于BLT+SRT组和SRT组(94.59%比81.73%比74.34%);RART+SRT组第一阶段眼震引出率、第二阶段SRT眼震引出率、责任半规管判定一致比例均高于BLT+SRT组,差异均有统计学意义(P<0.05);对责任半规管判定一致的患者进行复位治疗,BLT+SRT组痊愈率为92.59%(50/54),RART+SRT组为97.96%(96/98),两组痊愈率的比较,差异无统计学意义(χ^(2)=2.645,P=0.187)。Kappa一致性检验结果显示,RART与SRT在眼震引出率方面具有较好的一致性,一致率达94.59%(Kappa=0.638,P<0.001)。结论RART具有加速度大、安全性好、眼震引出率高的特点,能够有效诱发出HSC-BPPV特征性眼震,提高半规管定侧定位的准确性,为HSC-BPPV的临床实践提供更优化的检查方案,值得在临床中广泛推广。

Objective To explore the clinical value of the supine roll test(SRT),bow and lean test(BLT)and rapid axial roll test(RART)in the diagnosis of the affected side of horizontal semicircular canal benign paroxysmal positional vertigo(HSC-BPPV).Methods A total of 328 patients with HSC-BPPV in the First Affiliated Hospital of Xi'an Jiaotong University from March 2021 to April 2022 were selected,and were divided into SRT group(113 cases),BLT+SRT group(104 cases)and RART+SRT group(111 cases)according to different positioning tests.The BLT+SRT group and RART+SRT group were divided into two stages,and the first stage was performed with BLT or RART,and the second stage was performed with SRT.The nystagmus elicitation rates in different groups were compared,and the consistency of the nystagmus elicitation results between BLT/RART and SRT were compared by the Kappa consistency test.Results Among the 328 patients,there were 95 males and 233 females,aged from 18 to 233 years,with an average of(55.5±13.8)years.The elicitation rate of nystagmus in the RART+SRT group was higher than those in the BLT+SRT group and the SRT group(94.59%vs.81.73%vs.74.34%).The elicitation rate of the first stage nystagmus,the elicitation rate of the second stage SRT nystagmus,and the proportion of consistent determination of responsible semicircular canals in the RART+SRT group were all higher than those in the BLT+SRT group,and the differences were statistically significant(P<0.05).Patients with consistent determination of responsible semicircular canals were treated with reduction treatment,and the cure rate was 92.59%(50/54)in the BLT+SRT group and 97.96%(96/98)in the RART+SRT group,and there was no significant difference between the two groups(χ^(2)=2.645,P=0.187).The results of the Kappa consistency test showed that RART and SRT had good consistency in the elicitation rate of nystagmus,with a consistency rate of 94.59%(Kappa=0.638,P<0.001).Conclusions RART has the characteristics of high acceleration,safety,and high nystagmus elicitation rate.It can effectively induce HSC-BPPV characteristic nystagmus,improve the accuracy of lateral canal positioning,and provide a more optimized examination plan for the clinical practice of HSC-BPPV.It is worth of being widely promoted in clinical practice.