老年良性阵发性位置性眩晕急性期证素分布及前庭通路的特点分析

Analysis of the Distribution of TCM Syndrome Elements and Vestibular Pathways in the Acute Phase of Benign Paroxysmal Positional Vertigo in the Elderly

【目的】分析老年良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)急性期的中医证素分布及前庭通路的特点,探索本病老龄化发作相关因素,为中医临床辨证治疗提供依据。【方法】(1)使用临床流行病学调查方法,收集225例老年BPPV急性期患者的基础资料、四诊信息,使用SPSS 23.0建立数据库,对于频数超过15%的四诊信息条目进行系统聚类分析,同时进行病位、病性证素的分析;(2)选取20例累及单侧后半规管患者(观察组)与无眩晕发作史的老年人(对照组)进行队列研究,分析2组人群前庭通路相关指标的差异。【结果】(1)老年BPPV急性期最常见的四诊条目为头晕225例(100.00%)、眼花204例(90.67%)、恶心185例(82.22%)、行走不稳184例(81.78%)、皮肤偏暗或色素沉着173例(76.89%)、脉弦172例(76.44%)、脉滑150例(66.67%)、精神疲乏149例(66.22%)、肢体乏力147例(65.33%)、失眠140例(62.22%)、呕吐136例(60.44%)、口渴128例(56.89%)、口苦124例(55.11%)、纳呆121例(53.78%)等。证素方面,病性证素为动风、痰、湿、血瘀、气滞、气虚、气不固、血虚、阳虚、阴虚;病位证素为肝、脾、胃、肾、心、经络。(2)前庭功能相关检查:经颅多普勒超声(TCD)检查结果显示,观察组老年BPPV急性期患者的基底动脉平均血流速度明显低于对照组(P<0.01),而2组的血管阻力指数(RI)及搏动指数(PI)比较,差异均无统计学意义(P>0.05);前庭诱发肌源性电位显示:观察组双侧颈肌前庭诱发肌源性电位P13和N23的潜伏期均较对照组明显延长(P<0.05),而观察组患侧与健侧的P13与N23潜伏期比较,差异均无统计学意义(P>0.05);观察组的静态平衡功能指标与对照组比较,差异均无统计学意义(P>0.05)。【结论】老年BPPV急性期中医证素具有本虚标实的特点,涉及多个脏腑,治疗上应兼顾泻实补虚;同时,老年BPPV的发作可能存在基底动脉供血不足、潜在耳石器与前庭神经功能损伤,临床应密切关注患者的基底动脉供血及前庭功能状况。

Objective To investigate the distribution of traditional Chinese medicine(TCM)syndrome elements and the characteristics of vestibular pathways in the acute phase of benign paroxysmal positional vertigo(BPPV)in the elderly,and to explore the factors related to the onset of BPPV in old age,thus to provide evidence for the TCM diagnosis and treatment of BPPV.Methods(1)The clinical epidemiological survey methods were used for collecting the basic data and four-diagnosis information of 225 elderly patients with BPPV in the acute stage,and then a database was established with SPSS 23.0.Hierarchical cluster analysis was conducted in the four-diagnosis entries with a frequency of more than 15%,and the analysis of the disease-location and disease-nature syndrome elements was also performed.(2)A cohort study was conducted in 20 patients with unilateral posterior semicircular canal involvement(observation group)and in the elderly people without history of vertigo(control group),so as to analyze the differences of vestibular pathway related indexes between the two groups.Results(1)The most common four-diagnosis entries for senile BPPV in acute stage were vertigo(225 cases,100.00%),blurred vision(204 cases,90.67%),nausea(185 cases,82.22%),unstable gait(184 cases,81.78%),dark skin or pigmentation(173 cases,76.89%),stringy pulse(172 cases,76.44%),slippery pulse(150 cases,66.67%),mental fatigue(149 cases,66.22%),physical fatigue(147 cases,65.33%),insomnia(140 cases,62.22%),vomiting(136 cases,60.44%),thirst(128 cases,56.89%),biter mouth(124 cases,55.11%)and anorexia(121 cases,53.78%).In terms of syndrome elements,the disease-nature syndrome elements covered stirring up wind,phlegm,dampness,blood stasis,qi stagnation,qi deficiency,qi failing in arresting,blood deficiency,yang deficiency and yin deficiency;the diseases-location syndrome elements covered liver,spleen,stomach,kidney,heart,meridians and collaterals.(2)In terms of the vestibular function related indicators,the results of transcranial magnetic transcranial Doppler(TCD)showed that the mean blood flow velocity of basilar artery in elderly patients with acute BPPV in the observation group was significantly lower than that in the control group(P<0.01),but there was no significant difference in vascular resistance index(RI)and pulsatility index(PI)between the two groups(P>0.05).The results of vestibular evoked myogenic potentials showed that the latencies of P13 and N23 of bilateral cervical muscles in the observation group were significantly prolonged in comparison with those in the control group(P<0.05).There was no significant difference in the latency of P13 and N23 between the affected side and the healthy side in the observation group(P>0.05).And the static balance function indicators in the observation group did not differ from those in the control group(P>0.05).Conclusion In the acute stage of senile BPPV,the TCM syndrome elements are characterized by deficiency in the origin and excess in the superficiality and involve multiple zang-fu organs,so the treatment should follow the therapeutic principle of purging the excessive and replenishing the deficient.Moreover,the episodes of BPPV in the elderly may result from the insufficiency of the blood supply of the basilar artery,and the potential otolith and injured vestibular nerve function.Therefore,close attention should be paid to the blood supply of the basilar artery and vestibular function status in clinic.