前庭性偏头痛和梅尼埃病的临床特征及前庭功能检查的差异性分析

Analysis of clinical features and vestibular function differences between vestibular migraine and Meniere’s disease

目的探讨双温试验、视频头脉冲试验(vHIT)、前庭自旋转试验(VAT)对鉴别前庭性偏头痛(VM)和梅尼埃病(MD)的作用。方法选取确诊的VM和MD患者各26例,行双温试验、vHIT及VAT检查。双温试验记录半规管轻瘫值(CP)及反应弱侧冷热刺激的最大慢相角速度(SPV);vHIT检查记录各半规管增益值及扫视;VAT检查记录水平和垂直增益及相移、不对称偏向,通过统计学分析比较两种疾病各检查结果差异。结果VM与MD患者双温试验异常例数分别为7、15例,VM与MD患者CP值分别为(15.81±12.97)%、(28.88±15.38)%;经比较,两者异常率(P=0.025)及CP值(P=0.002)差异均具有统计学意义。VM、MD患者vHIT试验异常例数分别为6、11例,两种疾病vHIT检查异常率差异无统计学意义(P>0.05)。VM患者VAT检查异常24例,增益升高6例,增益下降16例,相移延迟16例。MD患者VAT检查异常19例,增益下降14例,相移延迟10例,两种疾病增益升高率差异具有统计学意义(P=0.023)。VM、MD患者双温试验和vHIT检查结果同时异常例数分别为1例和8例,两者差异具有统计学意义(P=0.028)。VM患者双温试验和VAT检查异常率差异具有统计学意义(P<0.001)。结论VM和MD临床特征存在差异,MD患者更容易出现水平半规管的损伤,且损伤程度更重。MD患者双温试验与vHIT结果同时异常率高于VM患者,而VM患者的VAT增益更易升高。此3种检查方法可以为两种疾病的鉴别提供依据。

Objective To investigate the effects of two temperature test,video-head impulse test(vHIT)and vestibular autorotation test(VAT)on vestibular migraine(VM)and Meniere’s disease(MD).Methods A total of 26 patients with VM and MD were assessed by dual temperature test,vHIT and VAT.Dual temperature tests were performed to record canal paresis(CP)value and maximum slow phase velocity(SPV)in response to hot and cold stimulation on the weak side.vHIT test recorded the gain value of each semicircular canal and saccadesis;Horizontal and vertical gain as well as phase shift and asymmetrical bias were recorded by VAT examination.The differences of each examination result between the two diseases were compared by statistical analysis.Results The abnormal number of dual temperature test in VM and MD patients was 7 and 15,respectively.The CP value of VM and MD patients was(15.81±12.97)%、(28.88±15.38)%.The difference of abnormal rate(P=0.025)and CP value(P=0.002)was statistically significant.The abnormal number of vHIT test in VM and MD patients was 6 and 11,respectively.There was no statistical difference for the abnormal rate of vHIT test between the two diseases.There were 24 patients with abnormal VAT,6 cases with increased gain,16 cases with decreased gain,and 16 cases with delayed phase shift.There were 19 patients with abnormal VAT,14 patients with decreased gain,and 10 patients with delayed phase shift in MD.The difference for the increase rate of gain between the two diseases was statistically significant(P=0.023).There were 1 and 8 abnormal patients in VM and MD dual-temperature test and vHIT,respectively,and the difference was statistically significant(P=0.028).There was a statistically significant difference in abnormal rate between VM patients’dual-temperature test and VAT examination(P<0.001).Conclusions There are differences in clinical characteristics between VM and MD.MD patients are more prone to horizontal semicircular canal injury,and the degree of injury is more serious.The abnormal rate of dual temperature test and vHIT in MD patients was higher than that in VM patients,and the VAT gain of VM patients was more likely to increase.The combination of the three tests can provide evidence for the differentiation of the two diseases.