老年人不明原因头晕与脑小血管病的相关性

Correlation between cerebral small vessel disease and unexplained dizziness in the elderly

目的探讨老年人不明原因头晕与脑小血管病的关系。方法回顾性分析2020-01—2022-01在郑州大学第二附属医院神经内科就诊的符合标准的132例老年头晕患者,分为头晕诊断不明确组、头晕诊断明确组。对比2组临床数据,并进行Logistic回归分析。结果神经内科老年人头晕诊断明确组中,头晕病变部位以前庭中枢系统(短暂性脑缺血发作、脑梗死)居多。头晕发病形式以反复发作性头晕(短暂性脑缺血发作、良性阵发性位置性眩晕等)最多。头晕诊断不明确组症状表现为头晕,头晕诊断明确组中眩晕多见。头晕诊断不明确组中,高脑小血管病影像学总负荷、中重度脑白质高信号、脑小血管病高于头晕诊断明确组,高中性粒细胞/淋巴细胞比值低于诊断明确组。中重度脑白质高信号是不明原因头晕的危险因素。脑白质负荷越高,残障量表评分越高。结论老年人头晕诊断不明确时,脑小血管病的中重度脑白质脱髓鞘可能导致头晕发生。

Objective To investigate the correlation between cerebral small vessel disease and unexplained dizziness in the elderly.Methods A retrospective case analysis was conducted for 122 older people with dizziness in the department of neurology of the Second Affiliated Hospital of Zhengzhou University from January 2020 to January 2022.The patients were divided into two groups:one group with unexplained dizziness and the other group with explained causes of dizziness.The clinical data of the two groups were compared and analyzed by Logistic regression.Results Damage in the vestibular central system(transient ischaemic attack、cerebral infarction)and recurrent paroxysmal dizziness(transient ischaemic attack、benign paroxysmal positional vertigo)are common in the group with definite diagnosis of dizziness in the elderly.The symptom of the group with unexplained dizziness was dizziness,and vertigo was more common in the group with explained causes of dizziness.In the group with unexplained dizziness,the high total imaging load of small vessel disease,white matter hyperintensities of moderate and severe degree,moderate to severe perivascular space in basal ganglia,cerebral small vessel disease were significantly higher,and the neutrophils to lymphocytes ratio was lower than that of the group with explained causes of dizziness.White matter hyperintensities of moderate and severe degree was the risk factor for explained dizziness.The higher degree of the white matter hyperintensities,the higher the disability scale score are.Conclusion When the diagnosis of dizziness is unclear in the elderly,moderate and severe degree white matter hyperintensities of cerebral small vessel disease may lead to dizziness.