单侧外周前庭病变患者摇头眼震的相关临床分析

Clinical Analysis of Head-Shaking Nystagmus in Patients with Unilateral Peripheral Vestibular Dysfunction

目的:探讨单侧外周前庭病变(UPVD)患者摇头眼震(HSN)的临床特征及意义。方法:纳入UPVD患者88例,回顾性收集患者的HSN及温度试验结果等,对患者的临床特征、HSN分类及其相关参数、HSN与半规管轻瘫(CP)值的相关性进行分析。结果:88例UPVD患者中,男∶女=1∶1.32,平均年龄(53.06±14.83)岁,HSN+患者53例(60.23%)。根据HSN及自发眼震(SN)是否阳性分成3组:HSN+/SN+组16例,HSN+/SN-组37例,HSN-/SN-组35例。HSN+/SN+组处于急性期(发病2周内)患者的比例、平均CP值和重度损伤患者的比例均高于其他2组(均P<0.05)。HSN包括单相眼震39例、双相眼震13例、倒错性眼震1例;单相眼震朝向健侧30例(76.92%),急性期14例(46.67%);双相眼震先健侧后患侧9例(69.23%),急性期3例(33.33%);双相HSN第一相的持续时间明显短于第二相(P<0.05),但最大慢相角速度(SPV)明显强于第二相(P<0.05)。结论:UPVD患者中HSN+/SN+患者多见于急性期、重度损伤。UPVD患者以单相HSN多见,单相HSN多朝向健侧,多见于急性期;双相HSN多为先健侧后患侧,急性期患者少见。双相HSN第一相SPV强而持续时间短,第二相SPV弱而持续时间长。

Objective:To explore the clinical characteristics and significance of head-shaking nystagmus(HSN)in patients with unilateral peripheral vestibular dysfunction(UPVD).Methods:Eighty-eight UPVD patients were included in this study,and their HSN type and caloric testing results were retrospectively collected.The clinical features,HSN type and related parameters,and correlation between HSN and semicircular canal paresis(CP)values were analyzed.Results:Eighty-eight patients with UPVD were included.The male/female ratio was 1/1.32,and the average age was(53.06±14.83)years.There were 53 HSN+patients(60.23%).Patients were divided into 3 groups based on the presence of HSN and spontaneous nystagmus(SN):HSN+/SN+group(16 patients),HSN+/SN-group(37 patients),and HSN-/SN-group(35 patients).Compared with the other 2 groups,the HSN+/SN+group included a higher proportion of patients in the acute stage(within 2 weeks of onset),greater average CP value,and higher proportion of patients with a profound lesion(all P<0.05).Qualitative analysis of HSN revealed 39 patients with monophasic HSN,13 cases with biphasic HSN,and 1 case of perverted HSN.Of the monophasic cases,30 showed fast phase beating toward the normal side(76.92%),and 14 were in the acute stage(46.67%).Of the biphasic cases,9 showed fast phases beating first toward the normal then toward the impaired side(69.23%),and 3 were in the acute stage(33.33%).The duration of the first phase of biphasic HSN was shorter than that of the second phase(P<0.05),but the slow-phase velocity(SPV)of the first phase was greater than that of the second phase(P<0.05).Conclusion:In patients with UPVD,those with HSN and SN are more commonly in the acute stage and frequently suffer profound lesions.Monophasic HSN is most common,with the fast phase directed toward the normal side,and is most often observed in the acute stage.Biphasic HSN more commonly shows fast phases beating first toward the normal side then toward the affected side and is less frequently seen in acute stage patients.In biphasic HSN,the first-phase SPV is high but duration short,and the second-phase SPV is low but duration long.