冷热试验联合视频头脉冲试验在评估周围性眩晕患者半规管功能中的应用效果

Application effect of caloric test combined with video head impulse test in assessment of semicircular canal function in patients with peripheral vertigo

目的探讨冷热试验联合视频头脉冲试验(vHIT)在评估周围性眩晕患者半规管功能中的应用效果。方法选取271例周围性眩晕患者为研究对象,包括良性阵发性位置性眩晕(BPPV)112例(BPPV组)、突发性耳聋(SD)伴眩晕66例(SD伴眩晕组)、梅尼埃病52例(梅尼埃病组)、前庭神经炎(VN)41例(VN组)。所有患者均行冷热试验及vHIT,比较各类周围性眩晕疾病患者冷热试验和vHIT的异常率,以及二者与总异常率的差异。结果BPPV组患者中冷热试验异常者35例(31.3%),vHIT异常者14例(12.5%),两项检查总异常率为33.0%;SD伴眩晕组患者中冷热试验异常者43例(65.2%),vHIT异常者28例(42.4%),两项检查总异常率为68.2%;梅尼埃病组患者中冷热试验异常者31例(59.6%),vHIT异常者22例(42.3%),两项检查总异常率为65.4%;VN组患者中冷热试验异常者38例(92.7%),vHIT异常者35例(85.4%),两项检查的总异常率为95.1%。4组的冷热试验异常率与总异常率差异均无统计学意义(均P>0.05)。BPPV组、SD伴眩晕组及梅尼埃病组的vHIT异常率均低于总异常率(均P<0.05)。BPPV组及SD伴眩晕组的冷热试验异常率均高于vHIT异常率(均P<0.05)。结论周围性眩晕患者半规管功能存在不同程度的损伤,冷热试验和vHIT联合应用可以提高半规管功能损伤的检出率,对周围性眩晕的诊断及预后评估具有重要参考价值。

Objective To investigate the application effect of caloric test combined with video head impulse test(vHIT)in the assessment of semicircular canal function in patients with peripheral vertigo.Methods A total of 271 patients with peripheral vertigo were selected as research subjects,including 112 cases of benign paroxysmal positional vertigo(BPPV)(BPPV group),66 cases of sudden deafness(SD)with vertigo(SD with vertigo group),52 cases of Meniere′s disease(Meniere′s disease group),and 41 cases of vestibular neuritis(VN)(VN group).All patients underwent caloric test and vHIT.The abnormal rates of caloric test and vHIT were compared between patients with various types of peripheral vertigo,and these two abnormal rates were compared with the total abnormal rate as well.Results In the BPPV group,35(31.3%)cases were abnormal in caloric test,14(12.5%)cases were abnormal in vHIT,and the total abnormal rate of the two examinations was 33.0%.In the SD with vertigo group,43(65.2%)cases were abnormal in caloric test,28(42.4%)cases were abnormal in vHIT,and the total abnormal rate of the two examinations was 68.2%.In the Meniere′s disease group,31(59.6%)cases were abnormal in caloric test,22(42.3%)cases were abnormal in vHIT,and the total abnormal rate of the two examinations was 65.4%.In the VN group,38(92.7%)cases were abnormal in caloric test,35(85.4%)cases were abnormal in vHIT,and the total abnormal rate of the two examinations was 95.1%.There was no statistically significant difference in the abnormal rate of caloric test or the total abnormal rate among the four groups(all P>0.05).The abnormal rate of vHIT was lower than the total abnormal rate in the BPPV,SD with vertigo,and Meniere′s disease groups(all P<0.05).The abnormal rate of caloric test was higher than the abnormal rate of vHIT in the BPPV and SD with vertigo groups(all P<0.05).Conclusion Peripheral vertigo patients′semicircular canal function is impaired to varying degrees.The combined application of caloric test and vHIT can improve the detection rate of semicircular canal dysfunction,which has great reference value in the diagnosis and the assessment of prognosis of peripheral vertigo.