持续性向地/背地变向性位置性眼震患者临床特点的对比分析

Clinical Characteristics of Patients with Geotropic or Apogeotropic Persistent Direc⁃tion-Changing Positional Nystagmus

目的:探讨伴持续性向地或背地变向性位置性眼震(DCPN)患者的临床特点及区别。方法:回顾性收集我院收治的眩晕患者56例纳入DCPN组,均经眼震视图检查及翻滚试验证实为持续性DCPN患者,并进一步分为背地DCPN亚组40例和向地DCPN亚组16例;收集同时期诊断为常见耳石症的患者66例纳入常见耳石组。记录患者的基本资料(年龄、性别、糖尿病、高血压、高脂血症、吸烟、饮酒、失眠等)以及发病诱因、耳部相关症状(听力下降、耳鸣等)特点;所有患者均完善头颅核磁、血管、眼震电图相关检查,比较常见耳石组与DCPN组及其亚组的临床特点、检查结果及预后等差异。结果:与常见耳石组相比,DCPN组的病程较长(P<0.05);与常见耳石组和背地DCPN亚组相比,向地DCPN亚组的平均年龄更小、女性比例更高、病程更长、听力下降和耳鸣患者的比例更高(均P<0.05)。常见耳石组患者首次复位后有84.8%的患者痊愈,1周内均痊愈;背地DCPN亚组首次复位后62.5%的患者痊愈,10 d内均痊愈;向地DCPN亚组首次复位后均无效,结合药物治疗和多次手法复位治疗,1个月后随访均痊愈,病程最长24 d。所有患者在3月后随访均未复发。结论:伴持续性向地/背地DCPN患者临床病程长,背地性DCPN危险因素与常见耳石症相似,提示两疾病的同源性;而向地性DCPN发病年龄偏轻、女性多见、病程更长,其发病机制可能与耳石粘附及内耳病变相关。DCPN患者手法复位的效果比常见耳石患者差,向地性DCPN患者的复位效果更差。

Objective:To investigate the clinical characteristics of geotropic and apogeotropic persistent direction-changing positional nystagmus(DCPN).Methods:A total of 56 patients with DCPN admitted to our hospital were retrospectively included in the DCPN group;persistent DCPN was confirmed in all patients by videonystagmography and the roll test.The patients were further divided into the apogeotropic(40 cases)and geotropic(16 cases)DCPN subgroups according to the direction of nystagmus.Sixty-six patients with common otolithiasis diagnosed during the same time frame were collected as the control group.The clinical data(age,gender,diabetes,hypertension,hyperlipidemia,smoking,drinking,insomnia,etc.),the provocating factors and the ear-related symptoms(hearing loss,tinnitus,etc.)were all recorded.All patients underwent head MRI,vascular examination,and electronystagmography.The clinical characteristics,examination results and prognosis of the groups and subgroups were compared.Results:Compared to the control group,the DCPN group showed a longer duration of disease(P<0.05).Compared with the control and apogeotropic DCPN subgroup,the geotropic DCPN subgroup displayed a younger average age,greater proportion of females,longer disease duration,and greater proportion of patients with hearing loss and tinnitus(all P<0.05).In the control group,84.8%of patients were cured after the initial reset,and all were cured within 1 week.In the apogeotropic DCPN subgroup,62.5%were cured after the initial reset,and all were cured within 10 days.In the geotropic DCPN subgroup,the initial reset was ineffective.Multiple subsequent resets were combined with drug therapy,and patients were cured at the 1-month follow-up.The longest disease duration was 24 days.There was no recurrence in any of the groups in the 3-month follow-up.Conclusion:The course of geotropic and apogeotropic DCPN is longer than that of common otolithiasis.The risk factors of apogeotropic persistent DCPN are similar to those of common otolithiasis,suggesting a homology between the two diseases.Geotropic persistent DCPN is associated with an earlier age of onset,a greater proportion of women,and longer duration of disease.Its pathogenesis may be related to otolith adhesion and inner ear disease.Manual resetting techniques are less effective in DCPN patients than they are in common otolithiasis patients,with the least effective results in geotropic DCPN patients.