中老年急性发作性孤立性眩晕的病因与临床特征分析

Analysis of causes and clinical features of acute paroxysmal isolated vertigo among middle-aged and elderly people

目的旨在探索急性发作性孤立性眩晕(acute paroxysmal isolated vertigo,aPIV)的常见病因构成及临床特征。方法从2019年1月—2021年8月在厦门市中医院脑病科及广西医科大学第一附属医院神经内科诊治的头晕/眩晕患者中,选取每次发作时间<2 min、病程<24 h、年龄≥40岁的中老年PIV患者共计312人,依据既定方案收集其临床特征并对病因进行分析,采用卡方检验判断临床特征与良性位置性阵发性眩晕(benign positional paroxysmal vertigo,BPPV)和急性血管性PIV(acute vascular PIV,avPIV)的关系。结果312例PIV患者中,BPPV占69.9%(n=218),其次是avPIV,占20.5%(n=64)。21例(9.6%)BPPV被诊断为后循环缺血,5例(7.8%)avPIV起初被诊断为BPPV。多数BPPV患者ABCD2评分<4,而多数avPIV患者ABCD2评分≥4,两组ABCD2评分差异有统计学意义(P<0.001)。统计分析发现BPPV组体位诱发试验阳性、床上变位诱发和眩晕发作时间<2 min所占比例高于avPIV组(P<0.001)。avPIV组男性、高血压、糖尿病、心房纤颤、自发眼震、复位不耐受所占比例高于BPPV组(P<0.001)。结论中老年PIV最常见的病因是BPPV和avPIV。通过某些特异性临床特征和针对性体格检查可以快速有效地对PIV的常见病因进行识别。

Objective To investigate the common causes and clinical features of acute paroxysmal isolated vertigo(aPIV).Methods 312 middle-aged and elderly patients with PIV(time of each attach<2 min,disease duration<24 hours,age≥40 years old)were selected out from patients with dizziness/vertigo in the Encephalopathy Department of Xiamen Hospital of TCM and the Neurology Department of the First Affiliated Hospital of Guangxi Medical University during the period from January 2019 to August 2021.Their clinical features were collected according to the established plan,and the etiology was analyzed.Chi-square test was used to determine the relationship between the clinical features and the benign positional paroxysmal vertigo(BPPV)and acute vascular PIV(avPIV).Results Among the 312 PIV patients,BPPV accounted for 69.9%(n=218),followed by avPIV,accounting for 20.5%(n=64).21 cases of BPPV(9.6%)were diagnosed as posterior circulation ischemia,and 5 cases of avPIVs(7.8%)were initially diagnosed as BPPV.Most patients with BBPV had ABCD2 score<4,while most patients with avPIV had ABCD2 score≥4;the difference in ABCD2 scores between the two groups was statistically significant(P<0.001).Statistical analysis showed that the proportion of posture-induced test positive,bed displacement induction,and vertigo onset time<2 min in the BPPV group was higher than that in the avPIV group(P<0.001).The proportion of male,hypertension,diabetes,atrial fibrillation,spontaneous nystagmus,and reduction intolerance in the avPIV group was higher than that in the BPPV group(P<0.001).Conclusion The most common causes of PIV in the middle-aged and elderly are BPPV and avPIV,which can be identified rapidly and effectively through some specific clinical features and targeted physical examination.