伴有心血管代谢疾病的眩晕患者的疗效影响因素

Factors Affecting Vertigo Treatment Outcome in Patients with Co-morbid Cardiometabolic Diseases

目的探讨伴有心血管代谢性疾病的眩晕/头晕患者的临床特征和近期结局影响因素。方法本研究纳入了2018年10月至2020年1月之间连续就诊于武汉同济医院眩晕专科门诊的伴有心血管代谢性疾病的眩晕/头晕患者。随访时获得的患者眩晕/头晕症状视觉模拟量表(Visual analogue scale,VAS)评分作为结局指标并按其分为完全缓解组和未完全缓解组,以t检验、Mann-Whitney U检验和χ2检验比较组间差异,近期结局影响因素通过线性回归模型进行评估。结果474名患者中女性多见(250名,60.5%)。在此群体中最常见的共患病是高血压(215[52.1%])。在没有纳入单纯BPPV患者的前提下,诊断以前庭型偏头痛(vestibular migraine,VM)最为常见,确定VM为149人(36.1%),其完全缓解率显著低于可能VM和本研究中其他眩晕/头晕疾病(P=0.028)。VAS评分从基线时的8分(四分位数间距:6-9分)下降至随访时的2分(四分位数间距:0-4分)。相较于未完全缓解组,完全缓解组中男性更多,具有更好的教育背景,HADS-D得分较低,VSS和DHI评分表明眩晕或头晕症状较轻,睡眠质量较好。多因素回归分析表明,基线时眩晕症状量表得分和医院焦虑抑郁量表的抑郁得分与随访的VAS评分之间具有显著相关性。结论伴有心血管代谢性疾病的眩晕/头晕患者的近期结局与就诊时症状严重程度和抑郁程度有独立相关性,医生有必要将情绪管理纳入综合治疗中。

Objective To investigate the clinical characteristics and short-term outcomes in vertiginous patients comorbid with cardiometabolic diseases.Methods Consecutive vertiginous patients with co-morbid cardiometabolic diseases seen at the vertigo and dizziness clinic at Tongji Hospital between October 2018 and January 2020 were included in this study.Patients with complete remission,as measured by the visual analogue scale(VAS)score,were compared to those with incomplete remission using Student’s t test,Mann-Whitney U test and chi-square test.Factors affecting shortterm outcomes were analyzed by linear regression models.Results The final sample included 474 patients,including 250 women(60.5%).The most common comorbidity was hypertension(n=215,52.1%).With benign paroxysmal positional vertigo excluded,vestibular migraine(VM)was the most common diagnosis.In the 149 patients with definite VM,the rate of complete remission was significantly lower than in patients with probable VM or other vertiginous disorders(P=0.028).The median VAS score decreased from 8 at baseline(interquartile range:6-9)to 2 at follow-up(interquartile range:0-4).Compared to patients with incomplete remission,those with complete remission were more likely men with better education,lower hospital anxiety and depression scale depression subscale(HADS-D)scores,milder vertigo or dizziness by vertigo symptom scale(VSS)and DHI scores and better sleep quality.Multivariate regression analysis showed a significant correlation between VAS scores at the last follow-up and VSS and(HADS-D)scores at baseline.Conclusion Short-term prognosis in vertiginous patients with co-morbid cardiometabolic diseases is independently correlated with the severity of vertigo/dizziness symptoms and depression.Therefore,attention must be paid to depressive disorders when managing vertiginous patients with co-morbid cardiometabolic diseases.