关于BPPV自愈患者的临床特征分析

Clinical analysis of patients with benign paroxysmal positional vertigo-spontaneously resolved

目的分析总结以发作性位置性眩晕为主诉但位置试验阴性的良性阵发性位置性眩晕(BPPV)患者,探讨BPPV自愈患者的临床特征及相关机制。方法回顾性分析2018年6月-2019年8月我院耳鼻喉科门诊确诊的167例以位置性眩晕为主诉的BPPV患者的临床资料,其中109例为主诉典型且变位试验阳性、并通过耳石手法复位治愈的BPPV(典型BPPV组),58例为主诉典型但变位试验阴性最终通过临床诊断为BPPV自愈(BPPV自愈组),两组患者从性别、年龄、眩晕病程及复发率方面进行统计学分析。结果①58例(34.7%)BPPV自愈患者中,男21例,女37例,男性自愈率较女性高(38.2%VS 33.0%),但无统计学差异(P=0.512)。②BPPV自愈组和典型BPPV组男女比例分别为1∶1.8和1∶2.2,均以女性发病多见,在性别分布上无显著差异。③BPPV自愈组平均年龄54.7±14.7岁,典型BPPV组平均年龄54.2±16.7岁,年龄分布无显著差别。④BPPV自愈组和典型BPPV组首诊病程大多数<2周,但自愈组病程1~2周所占比例较典型BPPV组高(36.2%VS 13.8%),差异有统计学意义(P=0.003)。⑤自愈组的复发率明显较典型BPPV组高,差异具有统计学意义(χ^(2)=11.846,P=0.001)。结论虽然BPPV在女性中更常见,但男性更趋于自愈,影响BPPV自愈的因素还需进一步探讨,手法复位可以缩短患者的自然病程。

Objective To compare the characteristics of the patients with probable benign paroxysmal positional vertigo which were spontaneously resolved,and BPPV not spontaneously resolved(manual reduction cured),describe and analyze the possible self-cured mechanism and related influencing factors.Methods The characteristics and clinical features of 167 cases with BPPV were retrospectively analyzed,from June 2018 to August 2019,diagnosed in the otolavyngology clinic of our huspital,in which 109 cases were diagnosed as BPPV with chief complaint of positional vertigo,positive in the positional test and cured by manual reduction.The other 58 cases were diagnosed as BPPV-spontaneously resolved,which were no observable nystagmus and no vertigo with any positional maneuver.The gender,age,course and recurrence rate were observed and analyzed during the follow-up period.Results①Among the 58 cases of BPPV-spontaneously resolved,21 were male and 37 were female.And the female self-healing rate is lower than men(33.0%vs 38.2%).②There was no statistical difference in gender distribution between the two groups.③There was no significant difference in age distribution.④The course of patients in the two groups were mostly within 2 weeks at their first visit to hospital,but the proportion in 1-2 weeks in the negative BPPV-spontaneously resolved group was higher than the positive group,and the difference was statistically significant.⑤The recurrence rate of BPPV-spontaneously resolved group was significantly higher than the manual reduction cured group(χ^(2)=11.846,P=0.001).Conclusion Although BPPV is more common in females,but a higher incidence of BPPV-spontaneously resolved was found in males.The factors affecting BPPV self-healing need to be further explored.Manual reduction can shorten the patient’s natural course.