静脉甘油试验和鼓室钆造影在梅尼埃病诊断中的价值

Diagnostic values of intravenous glycerol test and inner ear imaging with intratympanic gadolinium injection in Meniere's disease

目的观察静脉甘油试验和鼓室钆造影在梅尼埃病诊断中的价值。方法对2015年5月至2016年7月,在空军总医院航空航天眩晕诊疗研究中心诊治的89例梅尼埃病患者(其中6例为双侧发病,共95耳)进行静脉甘油试验(静脉点滴甘油果糖250ml,分别于点滴前,结束后1、2、3h进行纯音测听,甘油应用前后低中频区任意频率听阈下降≥15d B,或相邻两频率听阈下降≥10d B,或不连续的3个频率或以上下降≥10d B为阳性)。其中55例(4例为双侧发病,共59耳)24h后进行鼓室钆造影[鼓室内注入钆喷酸葡胺稀释液,并再过24h后进行内耳3D-FLAIR MRI扫描,进行三维重建,在水平半规管层面测量前庭中内淋巴间隙面积与同侧耳前庭总面积,求二者比值R,R=低信号区÷(低信号区+高信号区)×100%,>33.3%为阳性]。结果 95耳静脉甘油试验,阳性率65.3%(62/95),且试验中患者无头痛、头晕、恶心、呕吐、口渴、乏力、腹痛等不适反应。进行两项检查的59耳,甘油试验阳性率67.8%(40/59),鼓室钆造影剂阳性率96.6%(57/59),差异有统计学意义(χ2=16.741,P<0.01)。结论甘油试验和鼓室钆造影在梅尼埃病诊断中均有一定的参考价值,其中静脉甘油试验方法简单,患者无口服甘油引起的副作用,仪器和技术条件要求不高,适用于各级医院;鼓室钆造影阳性率更高,但检测设备和和技术要求高,适用于有条件的医疗单位进行精确诊断和研究。

Objective To study the value of intravenous glycerol test and endolymph space contrast examination by3D-FLAIR MRI after intratympanic gadolinium injection in the diagnosis of Meniere's disease. Methods Eighty nine casesof Meniere's disease (6 bilateral cases, 95 ears) diagnosed between May 2015 and July 2016 received glycerol fructose test(250 ml, with pure tone tests before and 1, 2 and 3 hour after infusion). Pure tone threshold improvement of 15 dB or moreat any 2 frequencies, or 10 dB or more at two adjacent frequencies or at any 3 frequencies or more was considered indicatinga positive result. Fifty five patients (including 4 with bilateral Meniere’s disease, total 59 ears) received 3D-FLAIR MRI 24h after intratympanic gadolinium injection. Results from the two tests were compared. Results Among the 95 ears, glyceroltest was positive in 62 ears (65.3%). There was no nausea, vomiting or other adverse reactions. In the 59 ears where resultsfrom both tests were available, the rate of positive 3D-FLAIR MRI with gadolinium contrast was 96.6%(57/59), while therate of positive glycerol test was 67.8% (40/59),(χ2=16.741, P<0.01). Conclusion Both glycerol test and 3D-FLAIR MRIwith gadolinium contrast examination showed certain value in the diagnosis of Meniere's disease. Glycerol test is simple,with minimal instrument and technique requirement, and probably suitable for medical centers of all levels. Whereas3D-FLAIR MRI with gadolinium contrast yields higher positive rate and increased accuracy in diagnosis and for research,but is technology demanding.