前庭功能检查在前庭性偏头痛患者预防性治疗疗效预测中的价值

Vestibular function tests for vestibular migraine:clinical implication of video head impulse and caloric tests

目的:回顾前庭性偏头疼(VM)患者的变温试验、视频头脉冲试验(vHIT)结果,评价前庭功能检查在预测VM患者预防性治疗疗效方面的价值。方法:收集VM患者初诊时变温试验及vHIT检查结果,并于预防性治疗6个月后复查,评价其症状改善情况,分成完全缓解(CR)组:无眩晕发作,不需要继续药物治疗;未完全缓解(UR)组:经治疗仍有眩晕发作,包括症状改善仍需继续治疗和症状完全无改善。结果:75例患者中15例(15.0%)变温试验异常,9例(12.0%)患者vHIT异常。治疗6个月后,58例(77.3%)患者完全缓解,17例(22.7%)患者未完全缓解,CR组和UR组之间变温试验和vHIT结果的异常率差异有统计学意义(P<0.05)。结论:变温试验和vHIT结果异常表明VM患者存在半规管功能异常,其眩晕症状与前庭外周功能异常密切相关,前庭功能检查结果异常的患者可能需要更长时间的预防性治疗或必要的康复治疗。

Objective：To review the results of caloric test and the video head impulse test （vHIT） in a cohort of VM patients and assessed the value of each for predicting the prognosis in VM patients. Method： A retrospective analysis was performed on VM patients in our vertigo clinic, vestibular function were assessed by caloric test and vHIT at the initial visit and 6 months t aftertreatment. Complete response（CR） was defined as no need for contin- ued medication, uncomplete response（UR） as improved symptoms but need for continued medication, no syrup- tomatic improvement. Result：At the initial evaluation, 15 of 75 patients（12.0%） exhibited abnormal vHIT results of 75（15.0%） exhibited abnormal caloric test results, 9 Six months later, 58 of 75 patients（77.3%） no longer required medication（CR）, while 17 （22. 7%）UR patients need for continued medication. The ratio of abnormal vHIT gain and abnormal calorie results were significantly different between group（CR）and group（UR）（P〈 0.05）. Conclusion： Abnormal vHIT and caloric test results revealed semicircular canal dysfunction in VM patients, peripheral vestibular abnormalities are closely related to the development of vertigo in VM patients and predicted prolonged preventive medication and vestibular rehabilitation requirement.