视频头脉冲试验在眩晕疾病诊断中的应用研究

Application of video head pulse test in the diagnosis of vertigo

目的探讨视频头脉冲试验(vHIT)评估周围性眩晕患者前庭眼反射(VOR)的临床价值。方法选取2019年4月-2020年10月收治的52例良性阵发性位置性眩晕(BPPV)患者和57例前庭性神经炎(VN)患者为研究对象,并选取同期30名健康者作为对照。采用vHIT定量测定一对水平半规管平面、两对垂直半规管平面的VOR增益值及相应3个VOR增益不对称值,记录眼球追赶扫视信息,计算vHIT异常比率、增益值不对称比阳性率及代偿性扫视阳性率,并通过受试者工作特征曲线(ROC)分析vHIT诊断VN的敏感度和特异度。结果与健康对照组和BPPV组比较,VN组患侧VOR增益值均减小,相应不对称值均增大。BPPV组与对照组增益值及增益不对称值比较,差异无统计学意义(P>0.05);VN组vHIT异常比率、增益值不对称比阳性率及代偿性扫视阳性率均高于BPPV组;vHIT诊断VN的敏感度为85.96%,特异度为93.33%,阳性预测值为96.08%,阴性预测值为77.78%。结论vHIT可通过VOR增益值、增益不对称值、vHIT异常比率、增益值不对称比阳性率及代偿性扫视阳性率对周围性眩晕患者的前庭功能进行评估,具有良好的临床应用价值。

Objective To investigate the clinical value of video head impulse test(vHIT)in evaluating vestibular ocular reflex(VOR)in patients with peripheral vertigo.Methods Fifty-two patients with benign paroxysmal positional vertigo(BPPV)and 57 with vestibular neuritis(VN)admitted to our hospital from April 2019 to Oct 2020 were selected as the research objects,and 30 healthy ones as the control.The VOR gain values of a pair of horizontal semicircular canal planes,two pairs of vertical semicircular tube planes and three corresponding VOR gain asymmetry values were measured by vHIT,and the information of eye catching saccade was recorded.The abnormal rate of vHIT,the positive rate of gain asymmetry ratio and the positive rate of compensatory saccade were calculated.The sensitivity and specificity of vHIT in the diagnosis of VN were analyzed by receiver operating characteristic curve(ROC).Results Compared with the control group and BPPV group,the VOR gain of VN group decreased,and the corresponding asymmetry increased.There were no statistically significant differences in the gain value and gain asymmetry value between the BPPV group and the control group(P>0.05).The vHIT abnormal rate,gain value asymmetry ratio positive rate and compensatory saccade positive rate of the VN group were higher than those of BPPV group.The sensitivity,specificity,positive predictive value and negative predictive value of vHIT for VN diagnosis were 85.96%,93.33%,96.08%and 77.78%respectively.Conclusion vHIT can evaluate the vestibular function of patients with peripheral vertigo through VOR gain value,gain asymmetry value,abnormal vHIT ratio,positive rate of gain asymmetry ratio and positive rate of compensatory saccade,which has good clinical application value.