头脉冲试验评价单侧外周前庭病变患者的前庭眼动反射功能

目的 观察单侧外周前庭病变(unilateral peripheral vestibular disorder,uPVD)患者的头脉冲试验(head impulse test,HIT)和冷热试验,探讨HIT在眩晕患者前庭眼动反射功能评价中的临床价值.方法 135例uPVD患者均在同一天进行HIT与冷热试验检查.HIT左右两侧各测试3次.结果 判别方法为:在HIT检查中,以出现≥2次典型的回跳性眼震为阳性结果,出现≤1次典型的回跳性眼震为阴性;记录冷热试验中的半规管轻瘫(canal paresis,CP)值.并以冷热试验为前庭眼动反射功能检查的标准方法,分析HIT的灵敏度、特异度、阳性预测值及阴性预测值.结果 所有135例uPVD患者中,HIT出现3次阳性的有19例,出现2次阳性的为26例,HIT检查阳性率为33.3%,且所有阳性结果均发生在患侧;HIT检查出现1次和未出现回跳性眼震的共90例,阴性率为66.7%.HIT与冷热试验相比较,CP<30%时,HIT阳性6例,阴性58例;CP值为30%～99%,HIT 阳性24例,阴性28例;CP值为100%时,HIT阳性15例,阴性4例.以冷热试验为前庭眼动反射功能标准测试方法,则HIT的灵敏度为54.9%,特异度为90.6%,阳性预测值为86.7%,阴性预测值为64.4%.结论 对uPVD患者水平半规管前庭眼动反射功能进行评价,HIT与冷热试验相比较,其特异度高而灵敏度较低,提示HIT不能取代冷热试验的临床价值或作为其筛查试验方法,但HIT可作为冷热试验的补充,两种方法应结合应用.

Abstract：

Objective To evaluate the function of vestibular ocular reflex (VOR) in patients with unilateral peripheral vestibular disorder (uPVD) by the head impulse test (HIT). Methods The HIT and caloric test were carried out in 135 cases of patients with uPVD. The results of HIT were considered as normal (negative reaction) and abnormal (positive reaction). The results of vestibular function evaluated by caloric test were divided into three kinds, including normal, decreased and deficit according to the degree of canal paresis as less than 30 percent, from 30 to 99 percent, and equal to 100 percent, respectively. The sensitivity, specificity, positive and negative predictive value of HIT in assessing the vestibular function was analyzed. Results For the 135 patients with uPVD, the HIT was normal in 90 ( 66.7% ) cases and abnormal in 45 (33.3%) cases. When the caloric test was normal, the HIT was normal or abnormal in 58 cases and 6 cases, respectively. And when the canal paresis was from 30 to 99 percent, the HIT was normal or abnormal in 28 and 24 cases, respectively. When the vestibular function was deficit (CP was 100% ), the HIT was normal or abnormal in 4 cases and 15 cases, respectively. When the results of caloric test were considered as the standard method to evaluate the VOR, the sensitivity, specificity, positive and negative predictive value of HIT were 54.9%, 90.6%, 86.7%, and 64.4%, respectively. Conclusions When assessing the function of VOR in patients with uPVD, the HIT could not replace the caloric test, but it can be a supplementary method. The information from both the HIT and caloric test can be combined to evaluate the patients with vestibular hypofunction comprehensively.

Evaluation of the vestibular ocular reflex in patients with unilateral peripheral vestibular disorder by the head impulse test

Objective To evaluate the function of vestibular ocular reflex (VOR) in patients with unilateral peripheral vestibular disorder (uPVD) by the head impulse test (HIT). Methods The HIT and caloric test were carried out in 135 cases of patients with uPVD. The results of HIT were considered as normal (negative reaction) and abnormal (positive reaction). The results of vestibular function evaluated by caloric test were divided into three kinds, including normal, decreased and deficit according to the degree of canal paresis as less than 30 percent, from 30 to 99 percent, and equal to 100 percent, respectively. The sensitivity, specificity, positive and negative predictive value of HIT in assessing the vestibular function was analyzed. Results For the 135 patients with uPVD, the HIT was normal in 90 ( 66.7% ) cases and abnormal in 45 (33.3%) cases. When the caloric test was normal, the HIT was normal or abnormal in 58 cases and 6 cases, respectively. And when the canal paresis was from 30 to 99 percent, the HIT was normal or abnormal in 28 and 24 cases, respectively. When the vestibular function was deficit (CP was 100% ), the HIT was normal or abnormal in 4 cases and 15 cases, respectively. When the results of caloric test were considered as the standard method to evaluate the VOR, the sensitivity, specificity, positive and negative predictive value of HIT were 54.9%, 90.6%, 86.7%, and 64.4%, respectively. Conclusions When assessing the function of VOR in patients with uPVD, the HIT could not replace the caloric test, but it can be a supplementary method. The information from both the HIT and caloric test can be combined to evaluate the patients with vestibular hypofunction comprehensively.