OVEMP在梅尼埃病和前庭性偏头痛鉴别诊断中的应用

Frequency-amplitude Parameters of Ocular Vestibular Evoked Myogenic Potentials in Meniere's Disease

目的研究眼肌前庭诱发肌源性电位(ocular vestibular-evoked myogenic potential,oVEMP)频率振幅比在单侧梅尼埃病(Meniere disease,MD)患者中的特异性以及在梅尼埃病诊断、鉴别诊断中的意义。方法对我科2018年1月至2019年1月确诊的单侧梅尼埃病患者34例(34患耳、34对耳)、前庭性偏头痛(vestibular migraine,VM)患者17例(34耳)和年龄相仿的健康志愿者15例(30耳)行oVEMP测试,分别用500Hz、1000Hz短纯音刺激,统计引出率;比较MD患耳组与其他各组oVEMP的振幅大小;计算并比较MD患耳组与其他各组的频率振幅比(在1000Hz频率刺激时引出的振幅与500Hz处引出振幅的比值);描述梅尼埃病患侧耳频率振幅比分别基于健康对照组、前庭性偏头痛组的受试者工作特征曲线(Receiver Operating Characteristic Curve,ROC)并行分析;计算频率振幅比与年龄、听力、病程的相关性系数并分析。结果梅尼埃病组有26例能引出oVEMP(引出率为76.47%),前庭性偏头痛组有14例(引出率为82.35%),健康对照组有13例(引出率为86.67%);振幅比较:500Hz频率刺激下引出的振幅在MD患耳组分别与MD对耳组、健康对照组、VM组的差异均无统计学意义(P>0.05)。1000Hz频率处引出的振幅在MD患耳组分别与MD对耳组、健康对照组、VM组之间的差异也均无统计学意义(P>0.05);频率振幅比比较:MD患耳组分别与MD对耳组、VM组、健康对照组相比频率振幅比均显著增大且有统计学意义(P<0.05);MD患耳频率振幅比基于健康对照组ROC曲线所得ROC曲线下的面积(Area Under Curve,AUC)数值为0.84,临界点为0.86,灵敏度为0.96,特异度是0.65;MD患耳基于VM组所得AUC为0.89,临界点为0.93,灵敏度为0.77,特异度为0.93;MD患耳频率振幅比与年龄、听力及病程相关性系数分别为0.05、0.13和0.31,显著性均无统计学差异(P>0.05)。结论梅尼埃病患者患耳oVEMP 1000/500频率振幅比无论与MD对耳组、健康对照组还是前庭性偏头痛组比较都存在较显著的增高,且与年龄、听力、病程无明显相关性,是一种较稳定的辅助工具用于MD的诊断以及与VM的鉴别诊断。

Objective To report ocular vestibular evoked myogenic potential(oVEMP)frequency-amplitude ratios in patients with unilateral Meniere disease(MD)and their values in MD diagnosis and differential diagnosis.Methods Thirty-four patients with unilateral Meniere's disease(34 disease ears and 34 contralateral ears)and 17 patients with vestibular migraine(VM)(34 ears)seen in our department from January 2018 to January 2019,as well as 15 age-matched healthy volunteers(30 ears),underwent oVEMP tests using tone bursts at 500 Hz and 1000 Hz.The extraction rates were calculated.Response amplitudes and frequency-amplitude ratios(amplitude at 1000 Hz/amplitude at 500 Hz)in MD patients were compared with those in VM patients and healthy volunteers.ROC curves of frequency-amplitude ratios were obtained and analyzed for all three groups of subjects.Correlation between the frequency-amplitude ratio and age,hearing and disease duration were also analyzed.Results oVOMPs were successfully extracted in 26 MD patients(76.47%),14 VM patients(87.50%)and 13 healthy controls(92.86%),respectively.oVOMP amplitudes at 500 Hz and 1000 Hz showed no statistically significant differences between the disease and contralateral ear in MD patients,or among the three groups of subjects(P>0.05).The frequency-amplitude ratio was significantly higher in the disease ear in MD patients than in the contralateral ear,in VM patients and in healthy controls(P<0.05).From ROC curves,the area under curve(AUC)was 0.84 with a cut-off point at 0.86(sensitivity=0.96,specificity=0.65)when MD patients were compared with healthy controls;and 0.89 with a cut-off point at 0.93(sensitivity=0.77,specificity=0.93)when compared with VM patients.The correlation coefficient between frequency-amplitude ratio and age,hearing and disease duration was 0.05,0.13 and 0.31,respectively(P>0.05).Conclusion The oVEMP frequency specific amplitude ratio(1000 Hz/500 Hz)in the disease ear in patients with MD is significantly higher than in the contralateral ear,and than in healthy individuals and VM patients.It is not correlated with age,hearing or disease duration.The ratio can be used as a relatively stable auxiliary tool in the diagnosis of MD and differential diagnosis from VM.