主观视觉水平线在单侧前庭周围性病变中的应用研究

Subjective visual horizontal in peripheral unilateral vestibular dysfunction

目的探讨外周单侧前庭功能减退患者的主观视觉水平线特点及其对前庭功能评定的临床价值。方法分别对85例外周单侧前庭功能减退患者及39名健康对照组人群行主观视觉水平线、主观视觉垂直线及冷热试验等前庭功能检测，以主观视觉水平线及主观视觉垂直线偏斜角度、冷热试验优势偏向（directional preponderance，DP）值、单侧半规管轻瘫（unilateral weakness，UW）值为参数，分析总结外周单侧前庭功能减退患者的主观视觉水平线特点，主观视觉水平线、主观视觉垂直线之间及其分别与DP、UW值、病程的相关性。以SPSS16．0软件对数据进行统计学分析。结果健康对照组主观视觉水平线、主观视觉垂直线的偏斜角度为-2°～2°。以此为判定阳性与阴性的标准。外周单侧前庭功能减退患者的主观视觉水平线、主观视觉垂直线阳性者分别为46例（54．1％）、43例（50．6％），二者比较差异无统计学意义（x2=12．5，P=0．481）；DP阳性者55例（64．7％），与主观视觉水平线、主观视觉垂直线比较，差异均无统计学意义（x2值分别为0．19、2．86，P值分别为0．164、0．067）。外周单侧前庭功能减退患者的主观视觉水平线与主观视觉垂直线偏斜角度呈正相关（r=0．939，P〈0．01），且二者与DP值均呈正相关（r值分别为0．648、0．658，P值均〈0．05），与UW值无相关性（r值分别为0．048、0．085，P值均〉0．05）。根据主观视觉水平线或主观视觉垂直线、DP、UW3个参数的阳性或阴性组合，可分别构成3种主要结果形式，即：主观视觉水平线（＋）DP（＋）uw（＋），主观视觉水平线（-）DP（＋）UW（＋），主观视觉水平线（-）DP（-）uw（＋）；主观视觉垂直线（＋）DP（＋）Uw（＋），主观视觉垂直线（-）DP（＋）UW（＋），主观视觉垂直线（-）DP（-）UW（＋）。以上6种形式的病程中位数分别为5．0、10．0、15．0d，5．0、9．5、14．5d，分别行多样本秩和检验，差异均有统计学意义（x2水平线=8．80，P=0．012；x2垂直线=6．26，P=0．040）。结论主观视觉水平线可以评估耳石器（椭圆囊）功能。外周单侧前庭功能减退患者的主观视觉水平线、主观视觉垂直线偏斜角度随病程和前庭代偿进程呈动态变化，可用于前庭静态代偿评定。

Objective To analyze the characteristics of subjective visual horizontal （SVH） and evaluate its clinical value for vestibular function in peripheral unilateral vestibular hypofunction （ UVH ）. Methods Eighty-five patients with UVH （ study group） and 39 normal persons （ control group） accepted vestibular function tests, including SVH, subjective visual vertical （SVV） and caloric test by videonystagmography. The parameters of the angle of SVH and SVV, directional preponderance （DP） and unilateral weakness（UW） of caloric test were observed. The correlation between SVH/SVV, DP, UW and the course of disease were investigated respectively. SPSS 16.0 software was used to analyze the data. Results Reference range of SVH and SVV was from - 2° to 2° in the control group. Among the 85 patients, 46 cases（54. 1% ） and 43 cases（50. 6% ） had the abnormal values of SVH and SVV respectively, with no statistical significance（x2 = 12. 5, P = 0. 481 ） by chi square test. Fifty-five cases （64. 7% ） with abnormal DP had no statistical significance when compared with SVH and SVV respectively （X2 values were 0. 19 and 2. 86, respectively, P value were 0. 164, 0. 067, respectively）. In UVH, there were positive correlation between SVH, SVV and DP（ r value was 0. 939, 0. 648, 0. 658, all P 〈 0. 05） respectively, but no correlation between UW and SVH or SVV（r value was 0. 048, 0. 085, all P 〉 0. 05 ）. According to the permutation and combination of the four parameters, positive or negative, three main groups could be defined [SVH（＋）DP（ ＋）UW（＋）, SVH（ -）DP（ ＋）UW（＋）, SVH（ -）DP（ -）UW（ ＋）; SVV（ ＋）DP （ ＋）UW（＋）, SVV（ -）DP（ ＋）UW（＋）, SVV（ -）DP（ -）UW（ ＋）]. The course of disease in the three main groups was positively skewed distribution,with median of 5.0, 10. 0, 15.0 d and 5. 0, 9. 5, 14. 5 d respectively. By Kruskal-Wallis Test, X2 value were 8.80 and 6. 26, respectively（P value were 0. 012, 0. 040, respectively） , with statistical significance between the above three main groups. Conclusions The SVH value can evaluate the function of the otolithic. The angle of SVH and SVV are changing in the course of disease, SVH and SVV can be used as a guidance of the vestibular compensation evaluation.