前庭诱发肌源性电位在眩晕患者中的临床应用

Clinical Application of Vestibular Evoked Myogenic Potential in Patients with Vertigo

目的观察眩晕患者中前庭诱发肌源性电位(vestibular-evoked myogenic potentials,VEMPs)的异常率指标,探讨其临床诊断价值。方法选取2018年1月~2019年3月在我门诊以眩晕为第一主诉就诊的69名患者,分别进行颈肌和眼肌前庭诱发肌源性电位(cVEMP,oVEMP)检查,依据诊断将患者分成良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)(n=17)、梅尼埃病(n=10)、突发性耳聋伴眩晕(n=19)、周围性眩晕(排除中枢性眩晕)(n=23)4个疾病类型组,与年龄、性别匹配的20例健康人作为正常对照组,对VEMPs的异常情况进行统计分析。结果17例BPPV患者cVEMP、oVEMP的不对称比异常率为17.65%、41.18%,双侧振幅比异常率为29.41%、52.94%;10例梅尼埃病患者cVEMP、oVEMP的不对称比异常率为10.00%、30.00%,双侧振幅比异常率为20.00%、50.00%;19例突聋伴眩晕患者cVEMP、oVEMP的不对称比异常率为36.84%、63.16%,双侧振幅比异常率为47.37%、89.47%;23例周围性眩晕(排除中枢性眩晕)患者cVEMP、oVEMP的不对称比异常率为34.78%、39.13%,双侧振幅比异常率为39.13%、52.17%。与正常组对比,BPPV患者组cVEMP双侧幅值比异常率、oVEMP的不对称比异常率、oVEMP双侧幅值比异常率有统计学意义(P<0.05),梅尼埃病患者oVEMP双侧幅值比异常率有统计学意义(P<0.05),突聋伴眩晕患者组均有统计学意义(P<0.05),周围性眩晕(排除中枢性眩晕)患者组均有统计学意义(P<0.05);各组疾病间cVEMP和oVEMP的不对称比异常率与双侧振幅比异常率数值比较均无统计学意义(P>0.05)。结论在以眩晕为症状的临床各疾病患者中,通过VEMPs检查对患者前庭功能的损伤起定位和辅助诊断作用,为临床医生提供的治疗依据。

Objective To observe the abnormal rate of vestibular evoked myogenic potentials(VEMPs)in vertigo patients and to explore its clinical diagnostic value.Methods From January 2018 to March 2019,69 patients with vertigo as the first complaint were examined by cVEMP and oVEMP.According to the diagnosis,the patients were divided into four groups:BPPV(n=17),Meniere's disease(n=10),sudden deafness with vertigo(n=19)and Peripheral vertigo(excluding central vertigo)(n=23).The abnormal situation of VEMPs was analyzed by taking twenty healthy people with age and sex matched as the normal control group.Results The abnormal rates of asymmetry ratio of cVEMP and oVEMP were 17.65%and 41.18%in 17 patients with BPPV,and the bilateral amplitude ratio were 29.41%and 52.94%.The abnormal rates of asymmetry ratio of cVEMP and oVEMP were 10.00%and 30.00%in 10 patients with Meniere's disease,and the bilateral amplitude ratio were 20.00%and 50.00%.The abnormal rates of asymmetry ratio of cVEMP and oVEMP were 36.84%and 63.16%in 19 patients with sudden deafness and vertigo,and the bilateral amplitude ratio were 47.37%and 89.47%.The abnormal rates of asymmetry ratio of cVEMP and oVEMP were 34.78%and 39.13%in 23 patients with peripheral vertigo(excluding central vertigo),and the bilateral amplitude ratio were 39.13%and 52.17%.Compared with the normal group,the abnormal rate of cVEMP bilateral amplitude ratio,the abnormal rate of oVEMP asymmetry ratio and the abnormal rate of oVEMP bilateral amplitude ratio were statistically significant(P<0.05)in BPPV group,the abnormal rate of oVEMP bilateral amplitude ratio in Meniere's disease group was statistically significant(P<0.05),and the abnormal rate in sudden deafness with vertigo group and peripheral vertigo(excluding central vertigo)were all statistically significant(P<0.05).There was no significant difference between the diesease groups(P>0.05).Conclusion In patients with vertigo as symptoms,VEMPs plays an important role in locating and assisting diagnosis of vestibular dysfunction,and provides further treatment basis for clinicians.