门诊主诉“眩晕或头晕”患者病因分层分析

Etiological Analysis of Outpatients with Vertigo or Dizziness

目的总结眩晕门诊以"眩晕或头晕"为主诉患者的病因分布特征,为眩晕或头晕患者的诊治提供参考。方法回顾分析2018年7月~2019年12月1 831例以眩晕或头晕为主诉就诊的门诊患者的临床资料,对所有患者以通用诊断标准为依据,根据患者症状、体征及辅助检查结果进行临床诊断,按患者性别和年龄进行病因分层分析,采用χ~2检验比较前5位疾病不同性别病因分层构成比。结果 1 831例患者年龄14~94岁;男661例,女1 170例,男女比例为1∶1.77;诊断排名前5的疾病分别为良性阵发性位置性眩晕(BPPV)720例(39.32%)、前庭性偏头痛(VM)420例(22.94%)、梅尼埃病(MD)132例(7.21%)、持续性姿势知觉性头晕(PPPD)127例(6.94%)及脑血管病所致头晕63例(3.44%),有169例(9.23%,169/1 831)原因不明;患者以45~59岁年龄段最多,共706例(38.55%);脑血管病导致的头晕在75~94岁患者中上升为第3位病因。在排名前5的疾病中,VM以女性多见,脑血管病所致头晕以男性多见(均为P<0.05),其余三种疾病无性别差异(P>0.05)结论眩晕或头晕是多病因多学科疾病的常见症状,最常见的病因为良性阵发性位置性眩晕和前庭性偏头痛;女性多于男性;发病高峰年龄段是45~59岁;随年龄的增长脑血管病导致的头晕比例增加;仍有部分眩晕或头晕患者原因不明。

Objective To study the spectrum of causes for patients with vertigo or dizziness.Methods Retrospective analysis were carried out with clinical data of patients with vertigo or dizziness, between July 2018 and January 2019.The target group were clinically diagnosed according to the general diagnostic criteria and the patient’s symptoms, signs and auxiliary examination results and were selected for etiology stratified analysis by gender and age. The χ2-test was used to compare the constitution ratio of etiological stratification by sex of the 5 most common diseases.Results A total of 1 831 patients were enrolled, 661 cases of male, female 1 170 cases. The male/female ratio was 1∶1.77. The 5 most common diseases were: benign paroxysmal positional vertigo(BPPV) 720 cases(39.32%), vestibular migraine(VM) 420 cases(22.94%), meniere disease(MD)132 cases(7.21%), persistent postural-perceptual dizziness(PPPD) 127 cases(6.94%), dizziness caused by cerebrovascular diseases 63 cases(3.44%). The age range was between 14 and 94 years old, and the number of patients aged 45 to 59 years old was the largest, 706(38.55%). Dizziness caused by cerebrovascular diseases rises to the third cause at the age of 75~94 years old.Stratified analysis of etiology by gender showed that among the top 5 diseases,vestibular migraine was more common in women,while dizziness caused by cerebrovascular disease was more common in men.Conclusion Vertigo/dizziness is a multidisciplinary disease with multiple causes, the most common diseases are BPPV and VM;more female than male. The peak age is 45~59 years old. With the growth of age, the proportion of dizziness caused by cerebrovascular diseases increases. There are still some patients with vertigo or dizziness whose causes are unknown.