前庭性偏头痛患者的前庭功能分析

The Vestibular Function in Patients with Vestibular Migraine

目的探讨前庭性偏头痛(vestibular migraine,VM)患者的前庭功能特点。方法对43例确诊为VM的患者(VM组)及30例健康志愿者(对照组)分别进行纯音测听、声导抗、冷热水试验(caloric test)、眼肌前庭诱发肌源性电位(ocular vestibular evoked myogenic potential,oVEMP)、颈肌前庭诱发肌源性电位(cervical vestibular evoked myogenic potential,cVEMP)和视频头脉冲试验(video head impulse test,vHIT),比较分析两组结果。结果VM组患者中纯音测听、冷热水试验、oVEMP及vHIT中的水平增益、代偿性扫视异常例数分别为10例(23.3%)、14例(32.6%)、18例(41.9%)、14例(32.6%)、13例(30.2%),显著高于对照组[分别为0例(0%)、3例(10.0%)、5例(16.7%)、1例(3.3%)、0例(0%)](P<0.05),而声导抗、cVEMP及vHIT中的水平不对称性比异常例数分别为3例(7.0%)、10例(23.3%)、3例(7.0%),与对照组[分别为0例(0%)、7例(23.3%)、2例(6.7%)]差异无统计学意义(P>0.05)。43例VM患者中,oVEMP振幅比(amplitude ratio,AR)及耳间不对称比(interaural asymmetric ratio,IAR)的异常率最高,分别为41.9%及34.9%。结论 VM患者存在一定程度的前庭功能损害,纯音测听、冷热水试验、oVEMP及vHIT中的水平增益、代偿性扫视结果有助于VM患者的诊断及与其他前庭性疾病的鉴别。

Objective To evaluate the vestibular function changes in VM patients.Methods Totally 43 patients diagnosed as VM and 30 healthy volunteers were evaluated by pure tone audiometry,acoustic impedance,caloric test,ocular vestibular evoked myogenic potential(oVEMP),cervical vestibular evoked myogenic potential(cVEMP)and video head impulse test(vHIT).Results The rates of abnormalaudiometry,caloric test,oVEMP,gain in horizontal semicircular canal and saccades of vHIT in theVM group 10 of abnormal(23.3%)、14 of abnormal(32.6%)、18 of abnormal(41.9%)、14 of abnormal(32.6%)、13 of abnormal(30.2%)respectively were significantly higher than those in control subjects(0 of abnormal、3 of abnormal(10.0%)、5 of abnormal(16.7%)、1 of abnormal(3.3%)、0 of abnormal,respectively(P<0.05).The rates of abnormaltympanometry,cVEMP,asymmetry in horizontal semicircular canal of vHIT in theVM group(3 of abnormal(7.0%)、10 of abnormal(23.3%)、3 of abnormal(7.0%))has no significantdifference between that in control subjects(0 of abnormal、7 of abnormal(23.3%)、2 of abnormal(6.7%))(P>0.05).In the 43 patients with VM,the abnormal rates of the amplitude(AR,41.9%)and interaural asymmetry ratio(IAR)in oVEMP were the highest,respectively.Conclusion Vestibular dysfunction may be common among vestibular migraine patients.The tests such as pure tone audiometry,caloric test,oVEMP and vHIT in the horizontal gain may help to diagnose VM and distinguish other vestibular diseases.