老年人良性阵发性位置性眩晕复发影响因素分析

Analysis of factors affecting the recurrence of benign paroxysmal positional vertigo in elderly patients

目的分析老年良性阵发性位置性眩晕（BPPV）复发的影响因素。方法回顾我院确诊、治疗、治愈后随访24个月，出现复发的老年BPPV患者59例作为复发组，同期随机抽取59例治愈后无复发的老年BPPV患者作为无复发组，对两组患者的年龄、性别、受累半规管、诱因、复发时间、头颅MRI、高血压、糖尿病、高脂血症、后循环缺血中阻塞性睡眠呼吸低通气综合征（OSAHS）等情况比较，并采用二分类Logistic回归分析老年人BPPV复发的影响因素。结果（1）患者复发高峰发生在首次治愈后的6～9个月。两组BPPV首次发作均以累及后半规管为主，受累半规管组间差异无统计学意义（x2=6．318，P=0．097）；（2）复发组患者复发累及相同半规管的有31例（52．5％），累及同侧不同半规管的有16例（27．1％），累及对侧有12例（20．3％）；（3）老年BPPV复发可能诱发因素包括失眠、精神心理、劳累、偏头痛、上呼吸道感染、咳嗽等6个因素，其中因失眠、精神心理影响的可能性最大（x2=4．933，P=0．026）；（4）合并高脂血症（OR=5．822，95％CI：2．317～14．629，P=0．000）和后循环缺血（OR=1．078，95％CI：1．044～8．267，P=0．041）为BPPV复发的危险因素；复发组腔隙性脑梗死发生率高于无复发组（x2=5．446，P=0．020）；梗死灶多位于额叶（x2=4．259P=0．039）、顶叶（x2=8．859，P=0．003）；提示小血管的硬化或闭塞可能是BPPV复发的原因；（5）患者首次发作、复发均首诊神经内科或急诊内科，复发时患者从其他首诊科室再就诊耳科专科的时间明显缩短。结论针对老年人BPPV可通过各种社会心理因素干预及减少诱发因素防止BPPV复发；有效控制血脂、改善后循环缺血，并采取针对性的干预措施对防止老年BPPV患者的复发有积极意义。

Objective To analyze factors for the recurrence of bcnign paroxysmal positional vertigo （BPPV） in the elderly. Methods A total of 59 elderly paticnts with BPPV who received diagnosis and treatment at our hospital, and experienced recurrence during a 24 month follow-up were selected as the recurrent group and 59 elderly patients without BPPV recurrence after treatment were randomly selected as the nonrecurrent group. Factors, including age, gender, semicircular canal involvement, precipitating factors, time of recurrence, magnetic resonance imaging of the head, hypertension, diabetes mellitus, hyperlipidemia, posterior circulation ischemia, and obstructive sleep apnea-hypopnea syndrome （OSAHS）, were compared between the two groups, and their relevance to BPPV recurrence was analyzed using binary logistic regression. Results The peak time of recurrence was 6-9 months after initial recovery. Posterior semicircular canal involvement was common in both groups at the onset of BPPV and there was no significant difference （X2= 6. 318, P= 0. 097）. In the recurrent group, recurrence affected the same semicircular canal in 31 patients （52.5%）, a different semicircular canal on the same side in 16 patients （27.1%）, and semicircular canals on the opposite side or both sides in 12 patients （20.3~~）. Possible precipitating factors for BPPV recurrence included insomnia, psychological factors, fatigue, migraine, upper respiratory infection and cough, with the first two showing the strongest association （Zz= 4. 933, P = 0. 026 ）. The combination of hyperlipidemia and posterior circulation ischemia increased the risk for BPPV recurrence （OR= 5. 822, 95~ CI：2.317 14. 629, P=0.000; 0R=1.078, 95% CI..1.044-8.267, P=0.041）. The incidence of lacunar infarction was significantly higher in the recurrent group than in the non recurrent group （ X2 =5. 446, P=0. 020）, and the infarcts were more often found in the frontal lobe （X2 =4. 259, P= 0. 039） and the parietal lobe （X2 =8. 859, P=0. 003）, indicating that arteriolar sclerosis or occlusion might be a cause for BPPV recurrence. Patients generally visited the neurology or emergency medicine department at the initial episode and the first recurrence, but were usually referred to the otorhinolaryngology department without much delay in later recurrent episodes. Conclusions BPPV recurrence can be reduced by instituting social and psychological intervention and by mitigating precipitating factors. It is of great significance to control blood lipid levels effectively, improve posterior circulation ischemia and take targeted interventions in order to prevent BPPV recurrence in the elderly.