视频头脉冲试验在眩晕疾病诊治过程中的临床研究

Clinical research of video head impulse test in the diagnosis of vertigo

目的探讨视频头脉冲试验(vHIT)评估中枢性眩晕和周围性眩晕的临床应用价值。方法选取2015年12月~2016年12月于我科就诊外周性眩晕者(外周组)38例、中枢性眩晕(中枢组)38例,及健康体检者40名作为对照组。采用vHIT检测获得各组3对半规管平面前庭眼反射(VOR)增益值和相应不对称值均值,计算vHIT异常比率、增益值不对称比阳性率及代偿性扫视阳性率。结果 (1)外周组患侧VOR增益值小于对照组和中枢组(均P<0.01),而中枢组和对照组比较,差异无统计学意义(均P>0.05);(2)外周组3个增益不对称值均高于对照组和中枢组(P=0.000)。中枢组水平增益不对称值与对照组比较,差异无统计学意义(P>0.05),垂直增益不对称值低于对照组(均P<0.05);(3)外周组vHIT异常比率、增益值不对称比阳性率及代偿性扫视阳性率均高于中枢组[36(94.74)vs 28(73.68);33(86.84)vs 13(34.21);29(76.32)vs 8(21.05);χ2=6.333、22.029、23.227,P=0.012、0.000、0.000]。结论vHIT通过VOR增益值、增益不对称值、vHIT异常比率、增益值不对称比阳性率及代偿性扫视阳性率评估眩晕患者的前庭功能,可以帮助鉴别诊断外周性眩晕和中枢性眩晕。

Objective To explore the clinical value of video head impulse test（vHIT） in the diagnosis of central vertigo and peripheral vertigo.Methods A total of 76 patients with vertigo in our department from Dec.2015 to Dec.2016 were divided into central vertigo group（n=38） and peripheral vertigo group（n=38）,and 40 healthy patients were selected as the control group.vHIT was used to quantitatively test the vestibule-ocular reflex（VOR） gains of 3 pair of horizontal semicircular canals and the corresponding asymmetrical value,and abnormal rate of vHIT,positive rate of the corresponding asymmetrical value and compensatory saccade were compared.Results（1）The VOR gains on the lesion side were lower in peripheral vertigo group than that in central vertigo group and in the control group（all P〈0.01）,and there was no significant difference between in the central vertigo group and in the control group（all P〈0.05）;（2）The 3 pair of the corresponding asymmetrical value were higher in peripheral vertigo group than that in central vertigo group and in the control group（P=0.000）.The differences were no statistically significant on corresponding asymmetrical value between in the central vertigo group and in the control group（P〈0.05）,vertical corresponding asymmetrical value was lower in the central vertig ogroup than in the control group（P〈0.05）;（3）The abnormal rate of vHIT,positive rate of the corresponding asymmetrical value and compensatory saccade were in peripheral vertigo group than those in central vertigo group [36（94.74） vs 28（73.68）; 33（86.84） vs 13（34.21）; 29（76.32） vs 8（21.05）; χ2=6.333,22.029,23.227,P =0.012,0.000,0.000].Conclusion vHIT can assess the vestibular function of vertigo patients through the VOR gain value,the corresponding asymmetrical value,abnormal rate of vHIT,positive rate of the corresponding asymmetrical value and compensatory saccade,and vHITcan help identify peripheral vertigo and central vertigo,which may be widely used in clinic.