前庭性偏头痛和梅尼埃病患者变温试验结果的比较

Comparison of caloric responses between vestibular migraine and Ménière disease patients

目的:分析前庭性偏头痛(VM)和梅尼埃病(MD)患者的变温试验特点,为鉴别2组疾病提供客观依据。方法:采用病例对照研究方法。入选左耳受损、听力受损程度分级为轻、中度MD病例(11例),VM病例(18例)与MD组相匹配,所有患者均进行变温试验检查。比较2组水平、垂直眼震的最大慢相角速度(SPVmax),根据水平和垂直SPVmax分别计算水平半规管轻瘫(CP)、垂直半规管CP;以SPVmax为5°/s作为分界点,分别判断单侧(UW-VR)、双侧前庭反应减弱(BW-VR)和单侧(UVR)、双侧垂直反应(BVR)阳性及双侧垂直反应阴性(NBVR);根据垂直SPVmax计算左、右耳垂直总反应(LV、RV)及耳间差异(IED-VR)。结果:2组患者各项水平SPVmax比较,除左侧冷试验(LC)外,其他VM组均较MD组大(P<0.05);其中右侧热试验(RW)2组均反应最大,而VM组(34.5±17.27)显著大于MD组(12.82±6.69,P<0.01)。各项垂直SPVmax仅RW时2组有差异(P<0.01),其他均差异无统计学意义;其中VM组以RW(6.00±4.45)、MD组以LC(1.27±2.00)最大,2组差异有统计学意义(P<0.01)。水平CP≥25%所占比例VM组(72.22%)和MD组(54.55%)差异无统计学意义,但UW-VR、BW-VR所占比例VM组(5.56%、0)较MD组(27.27%、18.18%)明显减少(P<0.05)。VM组和MD组的垂直CP≥25%差异有统计学意义(94.44%、27.27%,P<0.01),其中VM组UVR(左5.56%、右77.78%)、BVR(0)阳性、BVW(16.67%),MD组UVR(左9.09%、右0)、BVR(0)阳性、BVW(90.91%),2组比较均差异有统计学意义(均P<0.01);VM组双耳间垂直总反应差异有统计学意义(P<0.01,LV<RV),而MD组差异无统计学意义,其中VM组的IED-VR(左侧明显16.67%,右侧明显83.33%)和MD组(左侧明显36.36%,右侧明显9.09%,两侧无差别54.55%)比较差异有统计学意义(P<0.01)。结论:变温试验时VM患者比MD患者前庭反应更敏感,更易诱发垂直反应,可较好鉴别VM和MD。

Objective：To compare the features of caloric tests in vestibular migraine（VM）and Menière′s disease（MD）patients,and provide objective evidence for differentiating the 2groups of patients.Method：This casecontrol study included 11 MD patients with left ear involved and mild to moderate impaired hearing,and 18 matched cases with VM.All participants received caloric tests.Maximum slow phase velocities（SPVmax）were used to describe horizontal and vertical nystagmus respectively and were compared between the 2groups.Horizontal and vertical canal parasis（CP）were calculated according to respective SPVmax.Unilateral（UW-VR）or bilateral（BW-VR）weakness of vestibular response,and positive unilateral（UVR）or bilateral（BVR）vertical response or negative bilateral vertical response（NBVR）were judged by the boundary point of SPVmax of 5°/s respectively.Total left（LV）or right（RV）Vertical reactions were calculated accoeding to vertical SPVmax,and inter ears difference of vertical responses（IED-VR）calculated from LV minus RVResult：There were no significant differences in age and gender between the 2groups.Horizontal SPVmax of all of caloric tests of VM group,except the left cold（LC）,were statistically larger than that of MD group（P0.05）,and the maximum responses of right warm（RW）caloric test in VM group（34.50±17.77）were significantly greater than that in MD group（12.82±6.69）（P0.01）.Only the vertical SPVmax of RW of all caloric tests has statistically difference between the 2groups（P0.01）,and the maximum responses of RW caloric test in VM group（6.00±4.45）were significantly stronger than that of LC in MD group（1.27±2.00）（P0.01）.Horizontal CP≥25% of the 2groups（VM：72.22%,MD：54.55%）were not statistically different,while the proportions of UW-VR and BW-VR in VM group（5.56%,0）were significantly lower than that in MD group（27.27%,18.18%）（P0.05）.Vertical CP≥25% of the 2groups（VM：94.44%,MD：27.27%）were significantly different（P0.01）,and the proportions of positive UVR（left：5.56%,right：77.78%）and BVR（0）and NBVR（16.67%）in VM group were significantly different from that in MD group（UVR（left：9.09%,right：0）,BVR（0）,NBVR（90.91%））（P0.01）.There was statistically difference between LV and RV in VM group（P0.01,LVRV）,while no difference were showed in MD group.IED-VR in VM group（left intenser：16.67%,right intenser：83.33%）was statistically different from that in MD group（left intenser：36.36%,right intenser：9.09%,both no difference：54.55%）（P0.01）.Conclusion：Vestibular responses of caloric test are more sensitive,and vertical reactions are more easily induced in VM patients than in MD.Caloric test can be used to differentiate the 2groups of diseases.