良性阵发性位置性眩晕患者发作期动态平衡功能对复位后残余症状的影响:多中心前瞻性队列研究

Effect of dynamic balance during the onset of benign paroxysmal positional vertigo on residual dizziness after successful repositioning:a multicenter prospective cohort study

目的探讨良性阵发性位置性眩晕(BPPV)发作期动态平衡功能的特点及其对复位后残余症状的影响。方法2018年1月至2019年8月在上海市五家医院耳鼻咽喉头颈外科门诊连续入组首发单侧后半规管BPPV或水平半规管BPPV患者,在耳石复位前采用感觉统合试验(sensory organization test,SOT)测量其动态平衡功能,复位后随访1周~3个月,观察头昏、头晕、走路不稳等残余症状及持续时间。采用Stata 16.0统计学软件进行数据分析。结果共入组260例BBPV患者,排除17例后最终成功随访243例,其中男89例,女154例,年龄(52.9±13.0)岁,后半规管BPPV 175例,水平半规管BPPV 61例,7例管型转换(水平半规管转至后半规管)。243例患者中118例报告有残余症状,发生率为48.6%。SOT结果示:58.0%(141/243)的患者前庭觉不足者;41.6%(101/243)的患者SOT-总体平衡表现为"易跌倒"。残余症状表现:47例(39.8%)为不稳/飘浮感、35例(29.7%)为头昏/头沉感,22例(18.6%)为运动瞬时的晕感、15例(12.7%)难以描述。与无残余症状组相比,有残余症状组患者前庭觉不足(χ^(2)=67.25,P<0.001)和SOT-总体平衡为"易跌倒"(χ^(2)=74.78,P<0.001)的比例显著增高。Cox比例风险回归分析未发现SOT结果对残余症状持续时间有显著影响(前庭觉不足:HR=0.93,95%CI为0.48、1.80;SOT-总体平衡易跌倒:HR=0.90,95%CI为0.56、1.46)。Kaplan-Meier生存曲线分析示,不同SOT表现的患者残余症状持续时间差异无统计学意义[Log-rank(Mantel-Cox)test,P值均>0.05]。结论单侧BPPV患者发作期动态平衡功能受损以前庭觉不足为特征,残余症状主要表现为不稳/飘浮感和头昏/头沉感;动态平衡功能缺陷与复位后残余症状有关,但无法预测残余症状的存续时间。

Objective To explore the characteristics of dynamic balance during the onset of benign paroxysmal positional vertigo(BPPV)and its prediction of residual symptoms after successful repositioning.Methods From January 2018 to August 2019,patients diagnosed with unilateral posterior semicircular canal or horizontal semicircular canal BPPV were consecutively enrolled from five otolaryngology clinics in Shanghai.The dynamic balance function was measured by sensory organization test(SOT)before repositioning maneuver,and the residual symptoms and its duration were followed up from one week to up to three months.Results A total of 260 patients were recruited.After excluding 17 cases,243 cases were successfully followed up including 89 males and 154 females,with an average age of(52.9±13.0)years.There were 175 cases of posterior semicircular BPPV,61 cases of horizontal semicircular BPPV and 7 cases of canal conversion(from horizontal to posterior semicircular).Among 243 patients,118 cases reported residual symptoms,with an incidence of 48.6%.The results of SOT showed that 58.0%(141/243)of the patients had abnormal vestibular input and 41.6%(101/243)were categorized as"near falls".With respect to the detailed residual symptoms,47 cases(39.8%)reported unsteadiness or floating,35 cases(29.7%)had fogginess/heaviness feeling,22 cases(18.6%)had transient dizzy while head moving,and 15 cases(12.7%)reported that the symptom was too subtle to describe.Compared with the group without residual symptoms,the group with residual symptoms had more abnormal vestibular input(χ^(2)=67.25,P<0.001)and near falls(χ^(2)=74.78,P<0.001)as identified by SOT test.Cox proportional hazards regression failed to reveal any SOT results having significantly impact on the duration of residual symptoms[abnormal vestibular input(HR=0.93,95%CI:0.48,1.80),and near falls(HR=0.90,95%CI:0.56,1.46)].Kaplan-Meier survival analysis showed that there was no significant difference in the duration of residual symptoms among patients with different SOT manifestations[Log rank(Mantel-Cox)test,P>0.05].Conclusions The impaired dynamic balance during the onset of BPPV is characterized by"abnormal vestibular input".The residual symptoms are mainly characterized by unsteadiness or floating feeling.The defect of dynamic balance function is a predictor of the residual symptoms after successful repositioning,but not for the duration of such symptoms.