不同责任半规管BPPV与主诉症状关系分析

Analysis of the relationship between different semicircular canals BPPV and complaints symptoms

目的分析确诊良性阵发性位置性眩晕(BPPV)患者的位置性眩晕主诉特征,以及主诉症状与BPPV责任半规管定位诊断的相关性。方法对2022年2-3月因位置性眩晕就诊于该院患者100例完成详细病史问卷调查,以视频眼震图位置试验进行BPPV客观定位诊断,分析确定诊断BPPV与病史主诉的关系。结果100例患者中以坐起-躺下、左右翻身为眩晕主要主诉者分别为39、56例,两者分辨不清5例;位置试验阳性75例,其中BPPV确定诊断63例,其他前庭周围性眩晕12例。分析63例确定诊断BPPV患者的主诉症状,以坐起-躺下眩晕确诊垂直、水平半规管BPPV的灵敏度和特异度分别为70.7%和94.4%、5.6%和29.3%,以左右翻身眩晕确诊水平、垂直半规管BPPV的灵敏度和特异度分别为94.4%和70.7%、29.3%和5.6%。进一步分析63例BPPV患者其位置性眩晕的首发体位,以坐起-躺下者确诊垂直、水平半规管BPPV的灵敏度和特异度为76.9%和55.6%、44.4%和23.1%,左右翻身者确诊水平、垂直半规管BPPV的灵敏度和特异度为55.6%和76.9%、23.1%和44.4%。对30例可明确表述眩晕诱发较重体位侧别的BPPV患者进行分析,右侧位为较重侧13例,左侧位为较重侧17例,余33例对诱发眩晕的左右侧分别描述不清。结论位置性眩晕患者的主诉症状中,“坐起-躺下”和“左右翻身”性眩晕主诉分别对垂直、水平半规管BPPV诊断的灵敏度和特异度高,符合Ewald′s定律;而首发体位及症状较重的体位侧别,对BPPV责任半规管侧别定位诊断的灵敏度和特异度均不高。位置性眩晕患者主诉症状对BPPV快速筛查具有一定的临床价值,确定定位诊断要依靠位置试验。

Objective To analyze the characteristics of complaint symptoms of positional vertigo in patients with benign paroxysmal positional vertigo(BPPV)and the correlation between complaint symptoms and the localization diagnosis of BPPV responsible semicircular canal.Methods A total of 100 patients with positional vertigo from February to March 2022 in this hospital were completed a detailed medical history questionnaire.The objective location diagnosis of BPPV was carried out by video nystagmography and positional test,and the relationship between the diagnosis of BPPV and the complaint of medical history was analyzed.Results Among 100 patients,the main complaints of“sitting up-lying down”and“rolling over”on the bed were 39 and 56 cases respectively,and 5 cases could not distinguish between the two;75 cases were positive in positional test,including 63 BPPV and 12 other peripheral vertigo.In 63 patients diagnosed with BPPV,the sensitivity and specificity of vertical,horizontal semicircular canal BPPV diagnosed by sitting up-lying down were 70.7%and 94.4%,5.6%and 29.3%,respectively,and the sensitivity and specificity of horizontal,vertical semicircular canal BPPV diagnosed by rolling over were 94.4%and 70.7%,29.3%and 5.6%respectively.Further analysis of the first position of positional vertigo in 63 BPPV patients showed that the sensitivity and specificity of sitting up-lying down to diagnose vertical,horizontal semicircular canal BPPV were 76.9%and 55.6%,44.4%and 23.1%,and the sensitivity and specificity of rolling over to diagnose horizontal,vertical semicircular canal BPPV were 55.6%and 76.9%,23.1%and 44.4%.30 pat ients who could clearly express the side of heavier body position induced by vertigo were analyzed,including 13 patients on the right side,17 patients on the left side,and the remaining 33 patients could not clearly describe the side.Conclusion Among the complaint symptoms of patients with positional vertigo,the“sitting up-lying down”and“rolling over”have high sensitivity and specificity in the diagnosis of vertical and horizontal semicircular canal BPPV,which accords with Ewald′s Law.However,the sensitivity and specificity for the diagnosis of the responsible semicircular canal side of BPPV are low in the first position and the side position with more severe position.The chief complaint symptoms of patients with positional vertigo have a certain clinical value in rapid screening of BPPV,but the location diagnosis depends on the positional test.