HINTS联合血清IL-6诊断孤立性眩晕患者脑梗死的价值研究

Diagnostic value of HINTS combined with serum IL-6 for cerebral infarction in patients with isolated vertigo

目的 探讨头脉冲-眼震-眼偏斜(HINTS)联合血清IL-6诊断孤立性眩晕患者脑梗死的价值。方法 回顾性选择2022年6月至2023年10月青岛市第八人民医院收治的91例孤立性眩晕患者,根据临床评估及颅脑MRI检查结果分为脑梗死组23例和周围性眩晕组68例。比较两组患者的一般资料、实验室检查结果;所有患者入院即行HINTS床旁检查,根据HINTS检查结果初步诊断为脑梗死或周围性眩晕,与临床评估及颅脑MRI检查作出的诊断进行比较。采用多因素logistic回归分析影响孤立性眩晕患者脑梗死的危险因素。采用ROC曲线评估HINTS、血清IL-6及HINTS联合血清IL-6对孤立性眩晕患者脑梗死的诊断效能。结果 脑梗死组吸烟、糖尿病、高血压、椎基底动脉狭窄患者占比及FPG、血清IL-6水平均高于周围性眩晕组(均P<0.05)。多因素logistic回归分析显示高血清IL-6水平(OR=1.445,95%CI:1.016~2.054)是孤立性眩晕患者脑梗死的危险因素(P<0.05)。HINTS对孤立性眩晕患者脑梗死的诊断灵敏度为0.826(95%CI:0.612~0.951),特异度为0.868(95%CI:0.764~0.938),阳性预测值为0.679(95%CI:0.528~0.800),阴性预测值为0.937(95%CI:0.858~0.973),准确度为0.857(95%CI:0.768~0.922)。ROC曲线分析结果显示HINTS、血清IL-6、HINTS联合血清IL-6诊断孤立性眩晕患者脑梗死的灵敏度分别为0.826、0.696、0.826,特异度分别为0.868、0.735、0.897,AUC分别为0.847、0.751、0.919。结论 HINTS联合血清IL-6对孤立性眩晕患者脑梗死有较高的诊断效能。

Objective To assess the diagnostic value of head impulse-nystagmus-test of skew(HINTS)combined with serum IL-6 for cerebral infarction in patients with isolated vertigo.Methods Ninety-one patients with isolated vertigo admitted in Qingdao Eighth People's Hospital from June 2022 to October 2023 were enrolled,including 23 cases of cerebral infarction and 68 cases of peripheral vertigo diagnosed according to clinical evaluation and brain MRI.Compare the general information and laboratory examination results of two groups of patients,perform HINTS bedside examination immediately upon admission,and make a preliminary diagnosis of cerebral infarction or peripheral vertigo based on the HINTS examination results.Compare this with the diagnosis made by clinical evaluation and cranial MRI examination.Use multivariate logistic regression analysis to identify risk factors for cerebral infarction in patients with isolated vertigo.Use ROC curves to evaluate the diagnostic efficacy of HINTS,serum IL-6,and the combination of HINTS and serum IL-6 for cerebral infarction in patients with isolated vertigo.Results In cerebral infarction group,the proportion of smoking,diabetes,hypertension,vertebro-basilar artery stenosis patients,and the level of FPG,IL-6 were higher than those of peripheral vertigo group(all P<0.05).Multivariate logistic regression analysis showed that high serum IL-6 level(OR=1.445,95%CI:1.016-2.054)was the risk factor for cerebral infarction in patients with isolated vertigo(P<0.05).The diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy of HINTS for cerebral infarction in patients with isolated vertigo was 0.826(95%CI:0.612-0.951),0.868(95%CI:0.764-0.938),0.679(95%CI:0.528-0.800),0.937(95%CI:0.858-0.973)and 0.857(95%CI:0.768-0.922),respectively.ROC curve analysis showed that the AUC of HINTS,serum IL-6 and HINTS combined with serum IL-6 to diagnose cerebral infarction in patients with isolated vertigo was 0.847,0.751 and 0.919,with a sensitivity of 0.826,0.696 and 0.826,a specificity of 0.868,0.735 and 0.897,respectively.Conclusion The combination of HINTS with serum IL-6 has a high diagnostic efficacy for cerebral infarction in patients with isolated vertigo.