水平半规管良性阵发性位置性眩晕与前庭性偏头痛患者眼震特点及听-前庭功能

Characteristics of nystagmus and auditory vestibular function in patients with horizontal semicircular canal,benign paroxysmal positional vertigo and vestibular migraine

目的分析水平半规管良性阵发性位置性眩晕(HC-BPPV)与前庭性偏头痛(VM)患者眼震特点及听-前庭功能的差异。方法回顾性分析西宁市第一人民医院2018-01—2020-12收治的52例HC-BPPV与58例VM患者的临床资料,比较2组患者眼震视图各参数、异常率,对比2组患者听-前庭功能检查结果,包括纯音测试、眼震检查、冷热试验、前庭诱发的肌源性电位(VEMP)、听觉脑干反应(ABR)检查。结果HC-BPPV组患者平卧位(6.23±3.10)s、左侧卧位(8.55±3.36)s、右侧卧位(4.12±2.04)s的眼震潜伏期均明显高于VM组[(4.91±1.60)s、(5.65±1.29)s、(2.53±1.09)s],眼震持续时间[(35.69±5.60)s、(20.20±10.03)s、(45.38±11.58)s]及慢向速度[(12.35±6.13)°/s、(10.57±5.26)°/s、(17.66±6.50)°/s]均明显低于VM组[(60.28±11.05)s、(65.58±7.31)s、(90.61±8.26)s;(22.04±1.90)°/s、(25.38±11.71)°/s、(40.27±5.33)°/s](P<0.05)。HC-BPPV组患者凝视试验(1.92%)、扫视跟踪试验(0)、平稳跟踪试验(0)、视动性眼震检查(3.85%)、自发眼震试验(0)异常发生率均明显低于VM组(22.41%、31.03%、13.79%、29.31%、20.69%,P<0.05)。HC-BPPV组患者中枢性眼动(26.92%)、VEMP(13.46%)异常率明显低于VM组(50.00%、51.72%),冷热试验异常率(80.77%)明显高于VM组(20.69%,P<0.05)。结论眼震视图及听-前庭功能均能有效区别HC-BPPV与VM患者,与VM患者比较,HC-BPPV患者眼震潜伏期长,持续时间短,慢向速度低,眼震视图检查、中枢性眼动及VEMP异常发生率低,冷热试验异常发生率高,能够为临床诊治提供有效依据。

Objective To explore the differences in the characteristics of nystagmus and auditory vestibu⁃lar function between patients with horizontal semicircular canal-benign paroxysmal positional vertigo(HC-BPPV)and vestibular migraine(VM).Methods The clinical data of 52 patients with HC-BPPV and 58 patients with VM admitted to Xining First People’s Hospital from January 2018 to December 2020 were retrospectively analyzed.The results of vestibular function tests,including pure tone test,nystagmus test,caloric test,vestibular evoked myogenic potential(VEMP),and auditory brainstem response(ABR)test were compared.Results The nystagmus latency in the supine position(6.23±3.10)s,the left lateral position(8.55±3.36)s,and the right later⁃al position(4.12±2.04)s in the HC-BPPV group were significantly higher than those in the VM group[(4.91±1.60)s、(5.65±1.29)s、(2.53±1.09)s],nystagmus duration[(35.69±5.60)s,(20.20±10.03)s,(45.38±11.58)s]and slow velocity[(12.35±6.13)°/s,(10.57±5.26)°/s,(17.66±6.50)°/s]were significantly lower than the VM group[(60.28±11.05)s,(65.58±7.31)s,(90.61±8.26)s;(22.04±1.90)°/s,(25.38±11.71)°/s,(40.27±5.33)°/s](P<0.05).In the HC-BPPV group,the abnormal incidence rates of gaze test(1.92%),saccade tracking test 0,smooth tracking test 0,optokinetic nystagmus test(3.85%),and spontaneous nystagmus test(0)were significantly lower than VM group(22.41%,31.03%,13.79%,29.31%,20.69%)(P<0.05).The abnormal rates of central eye move⁃ment(26.92%)and VEMP(13.46%)in the HC-BPPV group were significantly lower than those in the VM group(50.00%,51.72%),and the abnormal rate of the caloric test(80.77%)was significantly higher than that in the VM group(20.69%)(P<0.05).Conclusion Both nystagmus view and auditory-vestibular function can effectively distinguish HC-BPPV and VM patients.Compared with VM patients,HC-BPPV patients have longer nystagmus la⁃tency,shorter duration and lower slow velocity,nystagmus view examination and central eye The incidence of ab⁃normal motion and VEMP was low,and the abnormal incidence of caloric test was high.