良性阵发性位置性眩晕患者耳石复位治疗后发生残余头晕的影响因素分析

Analysis of influencing factors of residual dizziness in patients with benign paroxysmal positional vertigo after canalith repositioning procedure

目的探讨良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者耳石复位(canalith repositioning procedure,CRP)治疗后发生残余头晕(residual dizziness,RD)的影响因素。方法选取2022年4月至2024年1月徐州医科大学第二附属医院BPPV患者207例,根据CRP后1个月眼震电图检查结果分为RD组(95例)与非RD组(112例),采用多因素logistic回归分析BPPV患者发生RD的影响因素,采用ROC曲线评估年龄和病程对BPPV患者发生RD的预测价值。结果207例患者中,男66例、女141例,年龄24~88岁,平均(60.4±13.8)岁。95例患者发生RD,发生率为45.9%;其中自诉头昏不适51例,行走不稳32例,颈部发紧27例。多因素分析结果显示,年龄越大(OR=1.032,95%CI:1.002~1.055,P=0.032)、病程越长(OR=1.144,95%CI:1.017~1.287,P=0.025)的患者发生RD的风险越高。ROC分析结果显示,年龄预测BPPV患者CRP治疗后发生RD的AUC为0.620(95%CI:0.544~0.696,P=0.003),诊断灵敏度为0.6742,特异性为0.5363;病程预测BPPV患者CRP治疗后发生RD的AUC为0.582(95%CI:0.503~0.661,P=0.043),诊断灵敏度为0.3681,特异性为0.7774,两者联合预测BPPV患者CRP治疗后发生RD的AUC为0.661(95%CI:0.587~0.735,P=0.001),诊断灵敏度为0.6842,特异性为0.5801。结论BPPV患者CRP治疗后RD的发生率较高,主要表现为头昏不适、行走不稳及颈部发紧;年龄、病程是BPPV患者CRP治疗后发生RD的独立危险因素,年龄联合病程对BPPV患者CRP治疗后发生RD的预测价值较高。

Objective To explore the influencing factors of residual dizziness(RD)in patients with benign paroxysmal positional vertigo(BPPV)after canalith repositioning procedure(CRP).Methods A total of 207 patients with BPPV in the Second Affiliated Hospital of Xuzhou Medical University from April 2022 to January 2024 were selected,and were divided into RD group(95 cases)and no RD group(112 cases)according to the results of nystagmography one month after CRP.The influencing factors of RD in BPPV patients was analyzed by multivariate logistic regression equation.The predictive value of age and course of disease on RD was evaluated by ROC.Results Among the 207 patients,there were 66 males and 141 females,aged from 24 to 88 years old,with an average of(60.4±13.8)years old.RD occurred in 95 patients,with an incidence of 45.9%.Multivariate regression analysis showed that patients with older age(OR=1.032,95%CI:1.002-1.055,P=0.032)and longer course of disease(OR=1.144,95%CI:1.017-1.287,P=0.025)had a higher risk of RD.ROC curve analysis showed that the AUC of age in predicting RD after CRP in BPPV patients was 0.620(95%CI:0.544-0.696,P=0.003),the diagnostic sensitivity was 0.6742,and the specificity was 0.5363.The AUC of the course of disease in predicting RD after CRP in BPPV patients was 0.582(95%CI:0.503-0.661,P=0.043),the diagnostic sensitivity was 0.3681,and the specificity was 0.7774.The AUC of combination of age and course of disease in predicting RD after CRP in BPPV patients was 0.661(95%CI:0.587-0.735,P=0.001),the diagnostic sensitivity was 0.6842 and the specificity was 0.5801.Conclusions The incidence of RD in patients with BPPV after CRP is higher,mainly manifesting as dizziness,unstable walking and neck tightness.Age and course of disease are independent risk factors for RD after CRP in BPPV patients.Age combined with course of disease has a higher predictive value for RD after CRP in BPPV patients.