慢性单侧前庭病变患者的临床特征分析

Analysis of Clinical Characteristics of Patients with Chronic Unilateral Vestibulopathy

目的:探讨慢性单侧前庭病变(CUVP)患者的临床特征。方法:34例CUVP患者纳入研究。详细采集病史;完善前庭功能评价,包括行双温试验并计算半规管轻瘫(CP)值,行视频头脉冲试验(v-HIT);行头晕残障量表(DHI)评分;进一步分析CUVP患者的CP值、病程及DHI值之间的相关性。结果:CUVP患者占同期就诊的单侧前庭病变患者的33.7%,平均年龄(49.84±9.31)岁,平均病程(9.1±6.0)个月,其中左侧病变16例,右侧病变18例。患者中,32.4%合并高血压,14.8%合并高脂血症,11.8%合并糖尿病,8.9%合并免疫异常。47.1%为原发性CUVP,52.9%为继发性;其中32.4%为慢性缺血性单侧前庭病可能,13.5%为前庭神经元炎,6.3%为持续性-姿势感知性头晕。双温试验平均CP值为(46.15±13.26)%,其中35.3%伴有vHIT异常。DHI总分平均值为(38.9±5.0)分。本组CUVP患者的CP值、病程及DHI值之间无相关性。结论:CUVP在临床上并不少见,病因诊断较困难,原发性CUVP最多见。CUVP患者临床症状的严重程度与外周前庭器官的损伤程度及病程无明显相关,提示外周前庭受损并不是其症状慢性化的唯一相关因素,需进一步评价其中枢代偿状态。

Objective:To explore the clinical characteristics of patients with chronic unilateral vestibulopathy(CUVP).Methods:Thirty-four patients with CUVP were admitted into this study.Details of disease history were collected.Vestibular function and bi-thermal caloric testing were performed,canal paresis(CP)was calculated,the video head impulse test(v-HIT)was completed,and the dizziness handicap inventory(DHI)score was determined.The correlation between CP value,disease course,and DHI value in CUVP patients was further analyzed.Results:CUVP patients accounted for 33.7%of patients with unilateral vestibulopathy during the same period,with an average age of(49.84±9.31)years and an average course of disease of(9.1±6.0)months,including 16 cases with left side CUVP and 18 cases with right side CUVP.Among the patients,32.4%were complicated with hypertension,14.8%with hyperlipidemia,11.8%with diabetes,and 8.9%with immune abnormality;47.1%were primary CUVP and 52.9%were secondary CUVP;32.4%presented with chronic ischemic unilateral vestibulopathy,13.5%with vestibular neuritis,and 6.3%with persistent postural-perceptual dizziness.The average CP value was(46.15±13.26)%,of which 35.3%was associated with vHIT abnormality.The mean DHI score was(38.9±5.0).There was no correlation between CP value,disease course,and DHI value in this group of CUVP patients.Conclusion:CUVP is not clinically uncommon;diagnosis of etiology is difficult,and primary CUVP is most commonly seen.There is no significant correlation between the severity of clinical symptoms and the extent of peripheral vestibular injury and the course of disease,suggesting that peripheral vestibular function injury is not the only factor related to the chronic symptoms and that further evaluation of central compensation is needed.