眼性前庭诱发肌源性电位临床检测技术专家共识

前庭诱发肌源性电位是一项用于客观评价前庭耳石器及前庭神经传导通路的检测技术。相对于比较成熟的颈性前庭诱发肌源性电位而言,眼性前庭诱发肌源性电位在刺激类型、电极导联方式等方面还存在诸多需要达成共识的关键环节。为促进国内规范的实验室检查标准,实现标准化的眼性前庭诱发肌源性电位记录和结果分析,特制订本检查记录和结果判读的临床检测技术专家共识,其内容主要包括眼性前庭诱发肌源性电位的基本概念、刺激和记录参数、观测指标以及结果判读和临床应用等关键环节。     

糖尿病大鼠颈性前庭诱发肌源性电位的观察

目的：观察糖尿病大鼠不同时期的颈性前庭诱发肌源性电位（cervical vestibular evoked myogenic potential ,cVEMP）的变化及意义。方法将220只雄性SD大鼠随机分为对照组（20只）及糖尿病组（200只）,应用链脲佐菌素（streptozotocin ,STZ）诱导糖尿病大鼠模型,再按照造模的时间将糖尿病组分为糖尿病4、6、8、10、12周组,每组40只,观察各组大鼠的一般情况及血糖、ABR、cVEM P检测结果。结果糖尿病组大鼠造模后出现多饮、多食、多尿等典型糖尿病症状,与对照组比较,血糖升高（P＜0．01）、体重下降（P＜0．01）;糖尿病组从第6周开始出现ABR反应阈值升高（P＜0．05）;糖尿病组cVEMP阈值第8周（53．87±11．16 dB nHL）、第10周（67．00±12．74 dB nHL）、第12周（67．00±9．23 dB nHL）升高（P＜0．01）,P1波潜伏期第8周（5．01±0．33 ms）、第10周（5．37±0．45 ms）、第12周（5．39±0．24 ms）延长（P＜0．01）,N1波潜伏期第10周（8．98±0．86 ms）、第12周（9．08±0．45 ms）延长（P＜0．01）,但糖尿病组P1－N1波间振幅与对照组比较差异无统计学意义（P＞0．05）。结论糖尿病大鼠从造模成功第8周开始,cVEMP阈值开始升高、P1波及N1波潜伏期延长,出现不同程度的前庭终器损伤,提示cV EM P可作为早期诊断前庭功能损害的方法之一。     

眼肌和颈肌前庭诱发肌源性电位在外周性前庭传导通路疾病诊断中的应用

目的:观察外周性前庭损害患者眼肌前庭诱发肌源性电位(oVEMP)和颈肌前庭诱发肌源性电位(cVEMP)的引出情况并探讨其临床诊断价值。方法:选择2011-03-2012-03期间在我院临床诊断为外周前庭损害,并接受门诊和(或)住院治疗的患者13例(14耳),进行双耳气导短纯音诱发的oVEMP和cVEMP检测,观察两种电位的引出情况,分析前庭上成分(椭圆/前庭上神经传入通路)和前庭下成分(球囊/前庭下神经传入通路)机能受损的状况。结果:13例(14耳,双侧1例)外周性眩晕患者包括:耳带状疱疹3例(3耳),听神经瘤3例(4耳),Ⅶ+Ⅷ颅神经牵拉伤1例(1耳),前庭神经炎2例(2耳),梅尼埃病3例(3耳),单侧内听道发育不全1例(1耳)。总体oVEMP正常引出2耳(正常引出率为14.3%),cVEMP正常引出3耳(正常引出率21.4%)。结论:外周性眩晕患者前庭耳石器及其传导通路机能受损的情况可以通过临床oVEMP和cVEMP检测进行客观评价,其表现形式根据病变波及的范围与程度不同各异。     

前庭诱发肌源电位在听神经瘤诊断中的应用

目的探讨前庭诱发肌源电位在听神经瘤临床诊断中的价值。方法选取听神经瘤患者(AN)26名为研究对象,听力正常健康人30名作为对照组,两组对象均接受眼性前庭诱发肌源性电位(o VEMP)测试和颈肌前庭诱发肌源性电位(cVEMP),分析对比两组之间oVEMPs和cVEMP的引出率及各参数指标。结果与对照组相比,听神经瘤组cVEMP和oVEMP的引出率较低,cVEMP的振幅减小,c VEMP和o VEMP的幅度比和不对称比(AR)增大,oVEMP的n10潜伏期较长,cVEMP和oVEMP结果与瘤体大小、听力损失程度无明显相关性。结论 c VEMP和oVEMP检测对听神经瘤的诊断有一定参考价值;引出率较低、VEMP振幅减小可能有助于听神经瘤筛查和诊断;cVEMP和oVEMP易于操作且稳定性高,联合检查可提高听神经瘤的检出率。     

小型猪肌源性诱发前庭电位的检测

目的探索小型猪肌源性诱发前庭电位(Vestibular-evoked myogenic potential,VEMP)的最佳检测方法。方法选取正常成年的雌性小型巴马香猪,以3%戊巴比妥钠+速眠新Ⅱ进行麻醉之后,用自制装置进行固定,1000Hz强短声诱发颈部伸肌肌源性电位和咬肌肌源性电位,并记录其波形;结果颈部伸肌诱发肌源性电位,第一个正向波P的潜伏期7.65±0.64ms,振幅1.66±0.34uv,80dBSPL的引出率为75%;咬肌诱发肌源性电位,第一个正向波P的潜伏期7.60±0.78ms,振幅1.31±0.28uv,80dBSPL的引出率为66%。结论小型猪颈部伸肌和咬肌在强声下诱发的肌源性电位潜伏期和阈值均一致;颈部伸肌部位所记录到的VEMF波幅稍高于咬肌部位记录到波幅;但相比之下,咬肌位置表浅,便于定位,肌肉组织发达,肌紧张性强,更易于肌源性诱发电位的记录。     

原发性良性阵发性位置性眩晕患者前庭诱发肌源性电位检测的意义

目的：探讨检测眼肌前庭诱发肌源性电位（oVEMP）和颈肌前庭诱发肌源性电位（cVEMP）对单侧原发性良性阵发性位置性眩晕（BPPV）患者进行可能发病部位的定位诊断价值。方法：对52例单侧原发性BP-PV患者（BPPV组）和38例正常人（对照组）分别进行气导短纯音诱发的oVEMP和cVEMP检测,分析两种反射的引出率、潜伏期、振幅等数据。结果;BPPV组患侧oVEMP的引出率为46．15％,cVEMP的引出率为67．31％;其健侧oVEMP的引出率为48．08％,cVEMP的引出率为65．38％。对照组左侧oVEMP的引出率84．21％,cVEMP的引出率92．11％;右侧oVEMP的引出率为81．58％,cVEMP的引出率为94．74％。对照组双侧cVEMP和oVEMP的P1、N1潜伏期及N1-P1振幅值差异均无统计学意义。BPPV组和对照组cVEMP和oVEMP耳间振幅比及不对称率差异有统计学意义（P〈0．05）。结论：单侧原发性BPPV患者双侧前庭耳石器传导通路功能受损状况,可以通过oVEMP和cVEMP检测进行客观评估,并且oVEMP的异常率比cVEMP高。     

眼性前庭诱发肌源电位影响因素的研究进展

眼性前庭诱发肌源电位是气导声刺激或骨导振动刺激人体前庭感受器(椭圆囊)或直流电刺激前庭上神经,于对侧眼下斜肌表面记录到的短潜伏期电位变化,是临床评价椭圆囊和/或前庭上神经通路功能的常用手段.国内外研究发现,oVEMP除存在个体间差异外,也会受测试方法、参数设置等因素影响.本文在前人研究结论基础上,对oVEMP常见影响因...     

年龄因素对直流电刺激诱发的前庭诱发肌源性电位的影响

目的 评估年龄因素对直流电刺激(GVS)诱发的颈肌前庭诱发肌源性电位(cVEMP)和眼肌前庭诱发肌源性电位(oVEMP)的影响。 方法 选择健康志愿者61名(122耳)作为研究对象,22~81岁,平均(45.0±13.8)岁。按年龄分为20~40岁组(26例,52耳)、41~60岁组(24例,48耳)以及>60岁组(11例,22耳),分别记录GVS-cVEMP和GVS-oVEMP。计算GVS-c/oVEMP在不同年龄段的引出率、阈值、潜伏期、振幅、振幅不对称比(interaural amplitude asymmetryratio,IAR),采用SPSS18.0软件进行统计学分析。 结果 GVS-cVEMP在20~40岁、41~60岁、>60岁年龄段的引出率分别为96.15%、89.58%和95.45%,组间比较差异无统计学意义(P>0.05)。GVS-oVEMP在20~40岁、41~60岁、>60岁年龄段的引出率分别为98.07%、91.67%和72.13%,随着年龄增长逐渐降低(P<0.05)。从参数分析来看,cVEMP的引出率、阈值、p1潜伏期、n1潜伏期、振幅和振幅不对称比在不同年龄组间差异无统计学意义(P>0.05);随着年龄增大,oVEMP的引出率下降、阈值增高、振幅减小(P<0.05),其他参数年龄组间差异无统计学意义(P>0.05)。 结论 随着年龄的增长,周围前庭系统的功能降低,有可能会对直流电刺激诱发的VEMP产生影响。     

前庭诱发肌源性电位临床应用的研究现状

前庭诱发肌源性电位(Vestibular Evoked Myogenic Potentials,VEMPs)是通过刺激微纹区的Ⅰ型毛细胞所产生的一种肌源性反应,主要反映球囊、椭圆囊的功能及前庭颈、前庭眼反射通路的完整性。VEMPs目前主要应用于前庭、中枢相关疾病的诊断及鉴别诊断,本文将就其信号产生、参数正常值及临床应用的研究进展进行综述。     

The Efficiency of Simultaneous Binaural Ocular Vestibular Evoked Myogenic Potentials: A Comparative Study with Monaural Acoustic Stimulation in Healthy Subjects

Objectives

To evaluate the test-retest reliability and convenience of simultaneous binaural acoustic-evoked ocular vestibular evoked myogenic potentials (oVEMP).

Methods

Thirteen healthy subjects with no history of ear diseases participated in this study. All subjects underwent oVEMP test with both separated monaural acoustic stimulation and simultaneous binaural acoustic stimulation. For evaluating test-retest reliability, three repetitive sessions were performed in each ear for calculating the intraclass correlation coefficient (ICC) for both monaural and binaural tests. We analyzed data from the biphasic n1-p1 complex, such as latency of peak, inter-peak amplitude, and asymmetric ratio of amplitude in both ears. Finally, we checked the total time required to complete each test for evaluating test convenience.

Results

No significant difference was observed in amplitude and asymmetric ratio in comparison between monaural and binaural oVEMP. However, latency was slightly delayed in binaural oVEMP. In test-retest reliability analysis, binaural oVEMP showed excellent ICC values ranging from 0.68 to 0.98 in latency, asymmetric ratio, and inter-peak amplitude. Additionally, the test time was shorter in binaural than monaural oVEMP.

Conclusion

oVEMP elicited from binaural acoustic stimulation yields similar satisfactory results as monaural stimulation. Further, excellent test-retest reliability and shorter test time were achieved in binaural than in monaural oVEMP.     

Clinical Testing of Otolith Function: Perceptual Thresholds and Myogenic Potentials

Cervical and ocular vestibular-evoked myogenic potential (cVEMP/oVEMP) tests are widely used clinical tests of otolith function. However, VEMP testing may not be the ideal measure of otolith function given the significant inter-individual variability in responses and given that the stimuli used to elicit VEMPs are not physiological. We therefore evaluated linear motion perceptual threshold testing compared with cVEMP and oVEMP testing as measures of saccular and utricular function, respectively. A multi-axis motion platform was used to measure horizontal (along the inter-aural and naso-occipital axes) and vertical motion perceptual thresholds. These findings were compared with the vibration-evoked oVEMP as a measure of utricular function and sound-evoked cVEMP as a measure of saccular function. We also considered how perceptual threshold and cVEMP/oVEMP testing are each associated with Dizziness Handicap Inventory (DHI) scores. We enrolled 33 patients with bilateral vestibulopathy of different severities and 42 controls to have sufficient variability in otolith function. Subjects with abnormal oVEMP amplitudes had significantly higher (poorer) perceptual thresholds in the inter-aural and naso-occipital axes in age-adjusted analyses; no significant associations were observed for vertical perceptual thresholds and cVEMP amplitudes. Both oVEMP amplitudes and naso-occipital axis perceptual thresholds were significantly associated with DHI scores. These data suggest that horizontal perceptual thresholds and oVEMPs may estimate the same underlying physiological construct: utricular function.     

气导声刺激前庭诱发肌源性电位在正常儿童中的表现

目的 探讨研究正常儿童中气导声刺激诱发的眼性前庭诱发肌源性电位(oVEMP)和颈性前庭肌源性诱发电位(cVEMP)的各项参数指标,并对正常值进行统计学处理分析。 方法 选择4~10岁听力正常健康儿童52例,以500 Hz短纯音作为刺激音,分别行 oVEMP和cVEMP检测,记录左、右耳引出率及波形参数,并采用SPSS统计软件进行统计学处理分析。 结果 双耳皆未引出oVEMP 2例,单耳可引出oVEMP4例,oVEMP总体引出率为92%。双耳皆未引出cVEMP 2例,cVEMP总体引出率为96%。oVEMP与cVEMP的P1潜伏期分别为(17.07±0.89)ms、(15.55±1.58)ms;N1潜伏期分别为(12.39±0.91)ms、(23.10±2.29)ms;N1P1间期分别为(4.68±0.88)ms、(7.83±1.56)ms;oVEMP与cVEMP的振幅分别为(7.24±4.79)μV、(197.40±118.37)μV。双耳间oVEMP及cVEMP振幅不对称比分别为(19.03±12.50)%、(22.16±18.64)%。患儿左右耳的潜伏期,P1N1间期及振幅差异无统计学意义(P>0.05)。 结论 绝大部分正常儿童经气导声刺激可引出oVEMP与cVEMP。该检测患儿依从性高,可用来评估儿童前庭功能。此研究结果可为我国的儿童气导VEMP提供正常参考值范围。     

Ocular vestibular evoked myogenic potential in patients with myasthenia gravis: A prospective clinical study

Objective

Myasthenia gravis (MG) is an archetypic disorder of neuromuscular junctions (NMJs) and autoantibody-mediated disease causing fatigable weakness of skeletal muscles with an ocular onset in up to 85%. The aim of this study was to detect extra ocular muscles (EOMs) abnormalities in MG patients using ocular vestibular evoked myogenic potential (oVEMP) n10 response.