高刺激率听性脑干反应评估前庭性偏头痛患者听觉脑干传导通路的意义

The Use of ABRs with High Stimulation Frequency Rates in Patients with Vestibular Migraine

目的探讨高刺激率听性脑干反应在前庭性偏头痛(vestibular migraine,VM)患者听觉传导通路评估的应用价值。方法依据VM诊断标准,选取VM患者32例(64耳)及年龄、性别相匹配的正常对照组25例(50耳),进行纯音测听、声导抗、高(51.1次/秒)和低(11.1次/秒)刺激率ABR测试,比较VM组及对照组以及VM组患者间歇期24例(48耳)的结果。结果低刺激率下,VM组的ABR波I、Ⅲ、V潜伏期及I-Ⅲ、Ⅲ-V、I-V波间期与对照组无明显差异(P>0.05);高刺激速率下,VM组的波Ⅲ、V潜伏期及I-Ⅲ、Ⅲ-V、I-V波间期均较对照组延长(P<0.05);VM组高低刺激率下Ⅰ-Ⅴ波间期差值(△Ⅰ-ⅤIPL)的异常率为71.88%(46/64),高于对照组4%(2/50)(P<0.05);VM组患者间歇期的△Ⅰ-ⅤIPL的异常率(29.17%,14/48)低于发作期(P<0.05)。VM组间歇期低、高刺激率下ABR各波潜伏期及波间期与对照组相比均无统计学差异(P>0.05),但△Ⅰ-ⅤIPL较对照组延长,且异常率高于对照组(P<0.05)。结论高刺激率ABR能够更敏感地发现VM患者听觉脑干通路的异常,为早期发现VM患者听觉功能的异常提供了一种可供选择的客观、敏感的评估手段。

Objective To study the use of auditory brainstem responses(ABRs)at high stimulus rates in patients with vestibular migraine(VM).Methods A total of 32 patients with VM(64 ears)and 25 cases without VM(50 ears)were enrolled in our study.Pure tone audiometry,impedance and auditory brainstem response(ABR,11 times/s and 51 times/s stimulation rates)were evaluated and compared between these two groups.Furthermore,ABRs results were compared between the VM patients in the acute stage and intermission.Results At the rate of 11 times per second,wave I,waveⅢ,wave V latencies and wave I-Ⅲ,Ⅲ-V,I-V interval peak latencies were not statistically significant differences between VM group and control group(P>0.05).However,at the rate of 51 times per second,waveⅢ,wave V latencies and wave I-Ⅲ,Ⅲ-V,I-V interval peak latencies in the VM group were longer than thosein the control group(P<0.05).The rate of abnormal high stimulation frequency rate ABRs(△Ⅰ-ⅤIPL)was difference between VM group 71.88%(46/64)and control group 4%(2/50)(P<0.05).Furthermore,this abnormal rate was difference between VM patients in the acute stage and intermission(29.17%,14/48)(P<0.05).There were no statistically significant differences in wave I,waveⅢ,wave V latencies and wave I-Ⅲ,Ⅲ-V,I-V interval peak latencies between VM group during attack-free periods and control group(P>0.05).Moreover,there was statistically significant difference at△Ⅰ-ⅤIPL between VM group during attack-free periods and control group(P<0.05).Conclusion ABR with high stimulation frequency rate can sensitively detect the abnormality of auditory brainstem pathway in VM patients,which provides a selective objective evaluation method for early detection of auditory dysfunction in VM patients.