老年与青中年良性阵发性位置性眩晕患者临床症状的比较分析

A comparative analysis of the clinical symptoms of benign paroxysmal positional vertigo between older and young and middle-aged patients

目的比较老年与青中年良性阵发性位置性眩晕(BPPV)患者在结构化头晕病史问诊中临床症状和确诊所需时间的差异。方法横断面研究。回顾性分析首都医科大学附属北京天坛医院眩晕临床诊疗与研究中心眩晕数据库中2019年1月至2021年10月确诊为BPPV的6807例患者临床资料,包括基线信息和结构化病史问卷中临床症状及首次症状至就诊的时间间隔,将患者分为老年组(≥65岁)和青中年组(<65岁),比较两组患者临床症状及确诊时间的差异。计数资料采用例(%)来表示,计数资料分析采用χ2检验或者Fisher精确概率检验进行分析;符合正态分布的计量资料采用xˉ±s表示,两组数据比较采用t检验进行分析。结果老年组年龄65~92(71±5)岁,青中年组18~64(49±12)岁。老年组患者眩晕(42.5%比49.1%;χ2=23.69,P<0.001)、头位或体位改变诱发的眩晕(52.4%比58.7%;χ2=22.31,P<0.001)、植物神经症状(10.1%比12.4%;χ2=7.09,P=0.008)发生率低于青中年组,而听力下降(11.8%比7.8%;χ2=27.36,P<0.001)、入睡困难(18.5%比15.2%;χ2=11.13,P=0.001)等伴随症状发生率高于青中年组,首次出现头晕症状至确诊时间长于青中年组(55.0%比38.5%;χ2=55.95,P<0.001)。结论与青中年患者相比,老年组患者的眩晕症状更不典型,伴随症状更复杂,对以头晕为主诉的老年患者,即使临床症状不典型也需完善位置试验,以明确有无BPPV的可能。

Objective To compare the differences in clinical symptoms and the time required for diagnosis of benign paroxysmal positional vertigo(BPPV)between older patients and young and middle-aged patients in the structured inquiry of dizziness history.Methods The medical records of 6807 patients diagnosed with BPPV from the Vertigo Database of Vertigo Clinical Diagnosis,Treatment,and Research Center of Beijing Tiantan Hospital,Capital Medical University,between January 2019 and October 2021 were retrospectively analyzed.The data included basic demographic information,clinical symptoms in a structured medical history questionnaire,and the time interval from the appearance of BPPV symptoms to diagnosis consultation.The patients were divided into the young and middle-aged group(<65 years old)and the older group(≥65 years old).The differences in clinical symptoms and consultation time were compared between these two groups.Categorical variables were represented by numbers(%),and compared using Chi-squared tests or Fisher's exact probability test for analysis;whereas,continuous variables conforming to normal distribution were represented by mean±standard deviation.Both data groups were compared and analyzed by Student'st-test.Results The mean age of the older group was 65-92(71±5)years,while the mean age of the middle-aged group was 18-64(49±12)years.The incidence of vertigo(42.5%vs.49.1%,χ2=23.69,P<0.001);vertigo triggered by changes in position of the head or body(52.4%vs.58.7%,χ2=22.31,P<0.001);and autonomic symptoms(10.1%vs.12.4%,χ2=7.09,P=0.008)were lower,but hearing loss(11.8%vs.7.8%,χ2=27.36,P<0.001)and sleep disorders(18.5%vs.15.2%,χ2=11.13,P=0.001)were higher in the older group than in the young and middle-aged group.The time from the appearance of dizziness to diagnosis was commonly longer in the older patient group than the other group(55.0%vs.38.5%,χ2=55.95,P<0.001).Conclusions Older patients with BPPV have more atypical symptoms and complex concomitant symptoms than young and middle-aged patients.For older patients with dizziness,positional testing is needed to confirm the possibility of BPPV even if the clinical symptoms are atypical.