摇头倾斜抑制试验和视频头脉冲试验鉴别前庭性偏头痛和梅尼埃病的应用研究

Application of Head Shaking Tilt Suppression Test and Video Head Impulse Test in the Antidiastole of Vestibular Migraine and Meniere's Disease

背景 摇头倾斜抑制试验(HSTST)与前庭小脑介导的中枢储存机制有关,视频头脉冲试验(vHIT)对外周前庭疾病的诊断起重要作用。目的 探索HSTST及vHIT在诊断前庭性偏头痛(VM)和梅尼埃病(MD)中的临床应用价值。方法 选取2021年7月—2022年12月就诊于贵阳市第二人民医院神经内科以眩晕或头晕为主诉、诊断为VM及MD的患者。完成病史采集、床旁查体;有听力损害者完善纯音测听检查;所有患者进行前庭功能检查,包括摇头试验(HST)、HSTST、温度试验及vHIT,计算倾斜抑制指数(TSI)。比较HST阳性的VM及MD患者临床特征及检查结果,绘制TSI鉴别HST阳性的VM和MD患者的受试者工作特征(ROC)曲线。结果 研究共纳入VM患者50例,其中HST阳性22例(44.0%),包括水平眼震19例(86.4%),垂直眼震3例(13.6%);MD患者45例,其中HST阳性23例(51.1%),均为水平眼震。对HST阳性的VM及MD的患者分析显示:VM患者女∶男=4.5∶1,MD患者女∶男=1∶1.3,VM患者头痛家族史比例高于MD患者(P<0.05);VM患者伴随呕吐、耳鸣、耳闷感、听力下降症状的比例(31.8%、18.2%、13.6%、13.6%)低于MD患者(73.9%、100.0%、82.6%、100.0%),伴随头痛症状的比例(77.3%)高于MD患者(8.7%)(P<0.05);纯音测听结果显示MD患者听力下降比例高于VM患者(P<0.001);VM与MD患者vHIT结果比较,差异有统计学意义(P<0.05);VM与MD患者的TSI比较[(25.41±12.15)%与(78.71±13.76)%],差异有统计学意义(P<0.05),TSI鉴别HST阳性VM和MD的灵敏度为0.90,特异度为0.95,ROC曲线下面积为0.962(95%CI=0.91~1.00),最佳截断值为0.66。结论 VM主要是中枢机制,HSTST联合v HIT可以作为鉴别VM和MD的辅助检查工具。

Background As revealed by previous studies,the head shaking tilt suppression test(HSTST)is associated with the vestibular cerebellum-mediated central storage mechanism and the video head impulse test(vHIT)is crucial for the diagnosis of peripheral vestibular diseases.Objective To explore the clinical application value of HSTST and vHIT in vestibular migraine(VM)and Meniere's disease(MD).Methods Patients presenting with vertigo or dizziness as the primary complaint and diagnosed with VM and MD were selected from the Neurology Department of the Second People's Hospital of Guiyang from July 2021 to December 2022.After collecting their medical history and performing bedside examinations,pure tone audiometry test was conducted on those with hearing impairment.All patients completed vestibular function tests,including head shaking test(HST),HSTST,caloric test,and vHIT,were performed,followed by calculating the tilt suppression index(TSI).Then the Clinical features and examination results of VM and MD patients with HST positive were compared,and the ROC curve of TSI was plotted to distinguish between the two groups of patients.Results Among the 50 VM patients involved in the study,22(44.0%)were HST positive,including 19(86.4%)exhibiting horizontal nystagmus and 3(13.6%)showing vertical nystagmus.Among the 45 MD patients,23(51.1%)were HST positive,all of whom were horizontal nystagmus.The analysis of the patients with HST positive showed that the female to male ratio in VM and MD patients was 4.5∶1 and 1∶1.3,respectively.The prevalence of family history of headaches was higher in VM patients compared to MD patients(P<0.05).VM patients exhibited lower proportions of vomiting,tinnitus,ear tightness,and hearing loss symptoms(31.8%,18.2%,13.6%,13.6%)compared to MD patients(73.9%,100.0%,82.6%,100.0%),with a higher proportion of accompanying headache symptoms(77.3%)than MD patients(8.7%)(P<0.05).Pure tone audiometry revealed a higher hearing loss rate in MD patients compared to VM patients(P<0.001).Significant differences were observed in vHIT between VM and MD patients(P<0.05).Then the TSI differed significantly between VM and MD patients[(25.41±12.15)%and(78.71±13.76)%,respectively](P<0.05).From ROC curves,the area under the curve(AUC)was 0.962(95%CI=0.91-1.00)with a cut-off point at 0.66(sensitivity=0.90,specificity=0.95).Conclusion Vestibular migraine primarily involves a central mechanism,and HSTST combined with vHIT can be used as auxiliary examination tools to differentiate diagnosis between VM and MD.