声诱发短潜伏期负反应对球囊和椭圆囊功能评估的意义

Significance of Acoustic Evoked Short Latency Negative Response in the Evaluation of Saccule and Utricle Function

目的通过分析大前庭水管综合征患者和单纯重度-极重度患者神经性聋患者声诱发短潜伏期负反应(acoustically evoked short latency negative response,ASNR)与前庭诱发肌源性电位(vestibular evoked myogenic potential,VEMP)的结果,探讨ASNR与球囊和椭圆囊功能的关系。方法研究对象为23例(46耳)大前庭水管综合征(large vestibular aqueduct syndrome,LVAS)和38例(76耳)重度-极重度感音神经性聋(SNHL)患者,对照组为10例(20耳)健康青年人,分析各组ASNR和VEMP的引出率、潜伏期、振幅等结果之间的关系。结果LVAS和SNHL患者中引出ASNR组cVEMP引出率和振幅与正常对照组无显著性差异(均为P>0.05),未引出ASNR组cVEMP引出率和振幅显著低于正常对照组(均为P<0.05);LVAS患者中引出ASNR组oVEMP引出率与正常对照组无显著性差异(均为P>0.05),但振幅显著高于正常对照组(P<0.01),LVAS患者中未引出ASNR组和SNHL引出ASNR组oVEMP引出率显著降低(P<0.01和P<0.05),但振幅与正常对照组无显著性差异(均为P>0.05)。SNHL患者中未引出ASNR组oVEMP引出率和振幅均显著低于正常对照组(P<0.01和P<0.05),N1、P1潜伏期均较对照组延长(均为P<0.05)。结论LVAS和SNHL患者中引出ASNR者球囊功能与正常组相似,未引出ASNR者常伴球囊功能减退或丧失;ASNR与反应球囊功能的cVEMP有较好的一致性,与反应椭圆囊功能的oVEMP之间的关系还有待进一步研究。

Objective To investigate the relationship between acoustically evoked short latency negative response(ASNR)and the function of saccule or utricle by analyzing the results of ASNR and vestibular evoked myogenic potential(VEMP).Methods The study included 23 subjects with large vestibular aqueduct syndrome(LVAS)and 38 subjects with sensorineural hearing loss(SNHL),and 10 healthy volunteers(20 ears)who were set as normal control group.The relationship between ASNR and the response rate,latency and amplitude of VEMP was analyzed.Results There were no significant differences in the response rate and amplitude of cVEMP between LVAS and SNHL groups with ASNR and normal control group,and they were significantly lower in those without ASNR group.The oVEMP response rate in LVAS group with ASNR was not significantly different from that in normal control group,but the amplitude was significantly higher than that in normal control group.For LVAS group without ASNR and SNHL group with ASNR,the oVEMP response rate decreased significantly,but the amplitude had no significant difference with the normal control group.The response rate and amplitude of oVEMP in SNHL group without ASNR were significantly lower than those in normal control group,and the latency of N1 and P1 were delayed.Conclusion The saccule function of LVAS and SNHL groups with ASNR was similar to normal group,and the saccule function was often degenerated or disfunction in those without ASNR.ASNR was correlated with the cVEMP which reflects saccule function,and the relationship between ASNR and oVEMP which reflects utricle function needs to be further studied.