前庭外周损伤患者自发眼震的特点及临床价值探讨

The analysis of the value of spontaneous nystagmus in peripheral vestibular hypofunction

目的:探讨前庭外周损伤患者自发眼震(SN)的特点及其临床价值。方法:以60例急性单侧前庭外周损伤眩晕患者为研究对象,均为前庭神经炎(VN),分别完成自发眼震、冷热试验测评。以SN强度和方向、冷热试验的优势偏向(DP)值及单侧半规管反应减退(UW)值为评定指标(异常者分别称为DP、UW),结合病程,分析SN的特点及其与病程、DP及UW间的关系。结果:60例中有SN者49例(81.7%),无SN者11例(18.3%)。SN强度范围0.5°/s^20.4°/s,与病程呈负相关(r=-0.478,P<0.01)。将SN强度按轻、中、重分组,病程中位数分别为6.5、5.0、3.0d,差异有统计学意义(χ~2=9.071,P<0.01)。有SN者中冷热试验DP 44例(89.8%),DP值正常5例(10.2%),SN强度与DP值呈正相关(r=0.513,P<0.01);存在UW者35例(71.4%)(UW侧别与SN方向不同者31例、相同者4例),双侧半规管反应减退者7例(14.3%),双侧半规管反应正常者7例(14.3%),SN强度与冷热试验UW值无相关关系(r=-0.321,P>0.05)。有SN和无SN者UW值分别为(40.9±26.3)%和(29.9±18.2)%,差异有统计学意义(F=4.497,P<0.05)。结论:急性前庭外周损伤者的SN强度多为中重度,强度随病程延长逐渐减弱或改变方向,且较无SN者的前庭损伤程度重。SN对前庭外周损伤侧别及代偿状态评估具有临床指导价值。

Objective：To study the characteristics and clinical value of spontaneous nystagmus in patients with peripheral vestibular dysfunction.Method：Sixty cases with acute unilateral peripheral vestibular dysfunction were studied.All were diagnozed as vestibular neuritis（VN）.The relationship between SN and disease duration,DP and UW were analyzed.Result：SN was present in 49 patients（81.7%）and absent in the remaining 11（18.3%）.The intensity of SN ranged from 0.5°/s-20.4°/s and had negative correlation with the disease duration（r=-0.478,P〈0.01）.The patients were divided into 3 groups（mild,medium and severe）according to SN intensity,with median duration of disease being 6.5d,5dand 3drespectively.The difference between groups was statistically significant（χ^2=9.071,P〈0.01）.The result of the caloric test were as following：caloric test revealed DP in 44 cases（89.8%）of SN;DP values were normal in 8 cases（10.2%）;SN intensity was positively correlated with DP value（r=0.513,P〈0.01）;unilateral weakness was found in 35 cases（71.4%）,with the direction of SN towards the weakness side in 4cases and towards the opposite direction in the remaining 31 cases;7 cases（14.3%）had bilateral weakness and 7 cases（14.3%）normal.There were no relationship between the intensity of SN and UW value（r=-0.321,P〉0.05）.The UW value of patients with SN（40.9±26.3）% was compared to the group without SN（29.9±18.2）%.The difference was statistically significant（F=4.497,P〈0.05）.Conclusion：The intensity of SN in patients with acute unilateral peripheral vestibular dysfunction was often moderate and severe.The intensity of SN waned as the disease progressed or the direction reversed,The vestibular injury in patient with SN was more severe than those without.SN is useful in clinical assessment of vestibular injury and compensatory status.