老年人良性阵发性位置性眩晕与脑血管病的相关性

The relationship between benign paroxysmal positional vertigo and cerebrovascular disease in the elderly

目的研究老年人良性阵发性位置性眩晕（BPPV）与脑血管病的相关性，为老年人BPPV的早期诊断、治疗、降低复发率提供循证医学的依据。方法连续入选2013年1月至2014年6月眩晕门诊老年BPPV初发患者80例作为试验组，同时选取本院同期正常体检非BPPv老年人80例作为对照组，比较两组基本特征、实验室检查、影像学检查指标，探讨老年BPPV易患人群的临床特点，采用单因素和多因素Logistic回归分析明确老年BPPV发病的独立危险因素。结果试验组腔隙性脑梗死、脑白质疏松、大血管狭窄发生率高于对照组（x2=10．180、4．606、3．956，P=0．001、0．032、0．047），试验组高脂血症、2型糖尿病发生率较对照组高（x2=5．013、6．041，P=0．025、0．014）；颈动脉斑块发生例数、总胆固醇、三酰甘油、血清尿酸两组间差异有统计学意义（x2=11．237、t=2．862、2．230、4．270，P=0．001、0．005、0．027、0．000）。采用多因素Logistic回归分析结果显示，试验组血清尿酸、高脂血症、2型糖尿病、高血压为老年人BPPV发生的独立危险因素（OR=1．006、7．104、3．152、3．273，P=0．005、0．000、0．004、0．002），且有颈动脉斑块BPPV患病风险显著增加（OR=384．570，95％CI：46．935～3151．055，P=0．000）。结论老年人BPPV与脑血管病变及脑血管病易患因素密切相关，在临床工作中应重视老年BPPV患者脑血管病患病情况，对其脑血管功能进行评估，重视颈动脉斑块这一重要指标，可为改善预后、预防复发提供参考。

Objective To investigate the relationship between benign paroxysmal positional dizziness （BPPV） and cerebrovascular disease and to promotethe practice of evidence-bases medicinein thediagnosis,treatment and recurrenceprevention of BPPV in the elderly. Methods A total of 80 elderly patients were consecutively recruited from the Dizziness Outpatient Clinic from January 2013 to June, 2014,with 80 non-BPPV elderly individuals receiving routine physical checkups during the same period serving as the control group. Clinical characteristics, lab test results and imaging data were compared between the two groups. Single factor and multivariate logistic regression analyses were conducted to identify independent risk {actors for BPPV in the elderly. Results The experimental group showed higher rates of lacunar infarction,leukoaraiosis and intracranial artery stenosis than the control group（x2 =10. 180,4. 606 and 3. 956,respectively;P=0. 001,0. 032 and 0. 047,respectively）. The prevalences of hyperlipidemia and type 2 diabetes were higher in the BPPV group than in the control group（x2= 5. 013 and 6. 041, respectively; P= 0. 025 and 0. 014, respectively）. Differences in number of carotid atherosclerotic plaque cases, total cholesterol, triglyceride, homocysteine and uric were found between the two groups （x2=11. 237,t=2. 862,2. 230 and 4. 270,respectively;P=0. 001,0. 005,0. 027 and 0. 000, respectively）. Multivariate logistic regression analysisfound that blood uric acid,hyperglycemia,type 2 diabetes and hypertension were independent risk factors for BPPV （OR= 1. 006,7. 104,3. 152 and 3. 273, respectively; P= 0. 005,0. 000,0. 004 and 0. 002, respectively）. The existence of carotid atherosclerotic plaques also increased the risk of BPPV（OR = 384. 570,95; CI： 46. 935-3151.055, P=0.000）. Conclusions BPPV in the elderlyis closely associated with cerebrovascular disease and its risk factors. Therefore, it is of great clinical significance to assess cerebrovascular function and carotid atherosclerotic plaque development for improved prognosis and effective prevention of recurrence of BPPV in the elderly.