良性阵发性位置性眩晕患者前庭诱发肌源性电位的特点

Cervical and ocular vestibular-evoked myogenic potentials in patients with benign paroxysmal positional vertigo

目的探讨良性阵发性位置性眩晕(BPPV)患者前庭诱发肌源性电位(VEMPs)的临床特征。方法对67例BPPV患者及19例(38耳)年龄、性别与之匹配的健康人进行颈肌前庭诱发肌源性电位(cVEMP)及眼肌前庭诱发肌源性电位(oVEMP)测试,分析对比VEMPs的引出率及各参数指标。结果 oVEMP在病例组患侧的引出率为43.3%、健侧为41.8%,对照组为71.1%;患侧与健侧比较差异无统计学意义(P>0.05),患侧、健侧与对照组比较差异均有统计学意义(P<0.01)。cVEMP在病例组患侧的引出率为62.7%、健侧为61.2%,对照组为84.2%;患侧与健侧比较差异无统计学意义(P>0.05),患侧、健侧与对照组间比较差异均有统计学意义(P<0.05)。oVEMP引出率较cVEMP引出率更低(P<0.05)。病例组患侧、健侧及对照组间oVEMP、cVEMP的阈值、各波潜伏期、振幅对比均无统计学差异(P>0.05)。结论 BPPV患者无论健侧还是患侧,其oVEMP和cVEMP引出率均显著下降,且以oVEMP降低为著,提示BPPV患者的耳石器,尤其是椭圆囊机能受损明显;引出VEMPs波形的BPPV患者,无论oVEMP还是cVEMP,其波形(参数)基本正常。

Objective To explore the clinical characteristics of vestibular-evoked myogenic potentials （VEMPs） in patients with benign paroxysmal positional vertigo （BPPV）. Methods We enrolled 67 BPPV patients as the observation group and 19 （38 ears） age- and gender-matched normal subjects as the normal control group. Both patients and normal subjects underwent conventional ocular-VEMP（oVEMP） and cervical-VEMP（cVEMP） tests in bilateral ears. The results were compared between the affected ears, the contralateral ears of the patients and the normal control ears. Results oVEMP was elicited in 29 affected ears （43.3%）, 28 contralateral ears （41.8%） and 27 normal ears （71.1%）. No significant difference was found in response rate between the affected ears and the contralateral ears （P~ 0.05）. However, significant difference could be found between the affected group （both affected ears and contralateral ears） and the normal group （P^0.01）. cVEMP could be elicited in 42 affected ears （62.7%）, 41 contralateral ears （61.2%） and 32 normal ears （84.2%）. There were no significant difference in response rate between the affected ears and the contralateral ears （P〉0.05）; however, significant difference could be found between the affected group （both affected ears and contralateral ears） and the normal group （P〈0.05）.The response rate of oVEMP was remarkably lower than that of cVEMP （P〈O. 05）. However, no significant difference was found in oVEMP or cVEMP parameters （threshold, N1 latency, PI latency, or amplitude） among the groups （P ~ 0. 05）. Oonclusion The response rates of oVEMP and cVEMP in the affected and the contralateral ears in the affected groups are significantly lower than those in normal controls; low response rates are more likely to appear in oVEMP tests. The waveforms of oVEMP and cVEMP tend to remain normal in patients with BPPV.