眩晕专病门诊就诊老年患者病因分析

Etiological factor distribution in elderly outpatients with vertlgo/dizziness

目的探讨眩晕患者年龄与病因分布，为诊疗提供临床依据。方法回顾性分析2015年4月至2017年4月陕西省人民医院眩晕专病门诊患者资料，并按照目前公认的诊断标准进行诊断。结果研究纳入以眩晕/头晕为临床主诉患者3 356例。各类眩晕疾病所占比例前7位依次为良性阵发性位置性眩晕1 320例（39.3%）、慢性主观性头晕680例（20.3%）、前庭性偏头痛386例（11.5%）、后循环缺血213例（6.4%）、梅尼埃病138例（4.1%）、前庭神经炎121例（3.6%）、前庭阵发症76例（2.3%）。老年患者中居前4位的病因依次是良性阵发性位置性眩晕498例（39.7%）、慢性主观性头晕279例（22.2%）、后循环缺血161例（12.8%）、前庭性偏头痛73例（5.8%）；非老年患者就诊居前4位的病因依次是良性阵发性位置性眩晕822例（39.1%）、慢性主观性头晕401例（19.1%）、前庭性偏头痛313例（14.9%）、前庭神经炎105例（5.0%）。结论老年患者后循环缺血比例高于非老年患者，前庭性偏头痛、前庭神经炎比例低于非老年患者。

ObjectiveTo clarify the distribution of etiological factors in elderly versus non-elderly outpatients with vertigo/dizziness for optimizing the diagnosis and therapy.MethodsWe retrospectively analyzed data of outpatients with vertigo/dizziness in Shaanxi Provincial People′s Hospital from April 2015 to April 2017 and conducted diagnoses in accordance with the currently wide-accepted diagnostic criteria.ResultsA total of 3 356 patients with chief complains of vertigo/dizziness were recruited, and their top seven etiological factors were benign paroxysmal positional vertigo（n=1 320, 39.3%）, chronic subjective dizziness（n=680, 20.3%）, vestibular migraine（n=386, 11.5%）, posterior circulation ischemia（n=213, 6.4%）, Meniere′s disease（n=138, 4.1%）, vestibular neuritis（n=121, 3.6%）, and vestibular paroxysmia（n=76, 2.3%）. The top four etiological factors for the elderly patients（n=1 255）were benign paroxysmal positional vertigo（n=498, 39.7%）, chronic subjective dizziness（n=279, 22.2%）, posterior circulation ischemia（n=161, 12.8%）, and vestibular migraine（n=73, 5.8%）; while the top four etiological factors for non-elderly patients（n=2 101）were benign paroxysmal positional vertigo（n=822, 39.1%）, chronic subjective dizziness（n=401, 19.1%）, vestibular migraine（n=313, 14.9%）, and vestibular neuritis（n=105, 5.0%）. The detection rate in elderly patients versus non-elderly patients was significantly higher in chronic subjective dizziness（22.2% vs.19.1%, P=0.032）and in posterior circulation ischemia（12.8% vs.2.5%, P=0.000）, and was significantly lower in vestibular neuritis（1.3% vs.5.0%, P= 0.000）, in vestibular migraine（5.8% vs.19.4%, P=0.000）and in other causes（1.0% vs.2.7%, P=0.002）.ConclusionsThe ratio of posterior circulation ischemia is markedly higher in elderly outpatients than in non-elderly outpatients, whereas the ratios of vestibular migraine and vestibular neuritis in elderly patients are lower than in non-elderly outpatients.