后半规管良性阵发性位置性眩晕患者眼震参数客观特征

Objective characteristics of nystagmus in patients with posterior semicircular canal benign paroxysmal positional vertigo

目的分析探讨后半规管良性阵发性位置性眩晕(benign positional paroxysmal vertigo,BPPV)患者眼震的参数特征及临床意义.方法研究对象为2016年1月至2017年7月就诊于天津市第一中心医院被确诊为后半规管管石症(posterior semicircular canal canalithasis,PSC-Can)的564例BPPV患者,其中男186例、女378例,年龄17~89岁,中位年龄57岁.应用视频眼震图仪客观记录PSC-Can患者Dix-Hallpike试验的诱发眼震,比较悬头位和坐起位诱发眼震的方向、潜伏期、持续时间以及强度等参数特点,采用SPSS17.0软件进行统计学分析.结果PSC-Can患者患侧Dix-Hallpike试验的悬头位和坐起位均可引出垂直扭转性眼震,垂直相眼震方向分别向上和向下;眼震的潜伏期:悬头位(2.65±1.92)s((x)±s,下同),坐起位(1.44±1.24)s;持续时间:悬头位(14.90±10.46)s,坐起位(15.28±8.06)s;眼震强度:悬头位(29.75±21.26)°/s,坐起位(14.08±9.48)°/s,二者强度之比近似2:1.悬头位诱发垂直方向眼震的潜伏期、强度均明显大于坐起位,差异均具有统计学意义(t值分别为13.831和17.296,P值均<0.01).悬头位和坐起位诱发眼震的持续时间接近,差异无统计学意义(t=-0.735,P>0.05).结论PSC-Can患者Dix-Hallpike试验悬头位和坐起位诱发垂直相眼震强度之比约为2:1,符合Ewald定律;其眼震方向、潜伏期及强度可以作为PSC-Can耳石定位诊断的参考指标.

Objective To analyze and discuss the parameters and clinical significance of nystagmus in patients with benign positional paroxysmal vertigo(BPPV)of posterior semicircular canal.Methods The subjects of the study were 564 BPPV patients diagnosed with posterior semicircular canal canalithis(PSC-can)from January 2016 to July 2017 in Tianjin No.1 Central Hospital,including 186 males and 378 females,with a median age of 57 years.The induced nystagmus in Dix-Hallpike test was recorded by video nystagmuo graph(VNG),and the direction,latency,duration time and intensity characteristics of nystagmus were compared with the position of hanging and sitting.SPSS17.0 software was used for statistical analysis.Results Vertical torsional nystagmus was both induced with the position of hanging and sitting during Dix-Hallpike test.The vertical direction of the induced nystagmus was upward and downward respectively.The latency,duration time and intensity of lesion side were L(2.65±1.92;1.44±1.24),D(14.90±10.46;15.28±8.06),and P(29.75±21.26;14.08±9.48).The latency and intensity in hanging position were higher than those of sitting.The intensity rate was about 2:1,with statistically significant difference(t=13.831,and 17.296,P all<0.01).The direction of the induced nystagmus was opposite to turning in HSC-Can BPPV.The intensity turning to normal side was larger than lesion side obviously.The intensity rate was about 2:1,the difference was statistically significant(t=17.296,P<0.01).There was no statistical difference of nystagmus during time between the two positions(t=-0.735,P>0.05).Conclusions The nystagmus intensity rate in Dix-Hallpike test between hanging and sitting position of lesion side in PSC-Can is 2:1,which conforms to the Ewald′s law.The direction,latency and intensity of nystagmus can be used as a reference index for the localization diagnosis of PSC-Canotolith.