摇头眼震在前庭外周损伤的临床价值探讨

A Study on Clinical Values of Head-shaking Nystagmus in Peripheral Vestibular Injury

目的探讨摇头眼震在前庭外周损伤的临床价值。方法83例单侧前庭外周损伤患者,分别按顺序规范完成自发眼震(spontaneous nystagmus,SN)、摇头眼震(head shaking nystagmus,HSN)及冷热实验(caloric test,CT)检查。以HSN与SN的强度和方向及CT结果的单侧半规管减退(unilateral weakness,UW)为观察指标,结合病程分析HSN的特点,及其与病程、SN与UW间的相互关系。结果83例患者中有HSN的59例,其中方向向健侧49例,向患侧8例,双相型2例。有SN的34例,其中HSN强度较SN增强的26例,无增强的8例。HSN、SN阳性率分别为:71.1%(59/83)、40.9%(34/83),其差异有统计学意义(c^(2)=29.323,P<0.01)。HSN强度与病程呈负相关(r=-0.357,P=0.019),HSN强度与UW值无相关关系(r=0.172,P=0.494)。有HSN者与无HSN者的UW及病程平均数分别为(35.746±25.243,6.200±6.136)、(16.317±12.176,8.112±5.892),其中病程差异无统计学意义(F=0.952,P=0.527),UW值差异有统计学意义(F=2.250,P=0.026)。结论HSN在前庭外周损伤及代偿评估中具有临床指导价值,并可指导前庭康复。前庭外周损伤患者中,有HSN较无HSN者前庭损伤重,HSN较SN的诊断价值更高。

Objective To study clinical values of head-shaking nystagmus in peripheral vestibular injury.Methods Spontaneous nystagmus(SN),head shaking nystagmus(HSN)and caloric test(CT)were evaluated in 83 patients with unilateral peripheral vestibular injury.Nystagmus intensity and direction,unilateral weakness(UW),disease course,characteristics of HSN and correlation between HSN and disease course,SN and UW were analyzed.Results HSN was seen in 59 patients,with direction to the healthy side in 49,to the affected side in 8 and bipolar in 2.SN was seen in 34 patients,with HSN stronger than SN in 26 and no enhancement in 8.The detection rate of HSN and SN was 71.1%(59/83)and 40.9%(34/83)respectively(c^(2)=29.323,P<0.01).HSN intensity was negatively correlated with the course of disease(r=-0.357,P=0.019)but not with UW(r=0.172,P=0.494).UW in patients with HSN(35.746±25.24)was greater than in those without(16.317±12.176)(F=2.250,P=0.026),while disease course(6.200±6.136 vs 8.112±5.892)was not significantly different(F=0.952,P=0.527).Conclusion HSN has clinical values in guiding evaluation of vestibular peripheral injury and compensation,as well as vestibular rehabilitation.Peripheral vestibular injury in patients with HSN is more severe than in those without,and the diagnostic value of HSN is higher than that of SN.