视频头脉冲试验与冷热试验的相关性研究

目的分析常见外周性眩晕疾病视频头脉冲试验与冷热试验的特征,探讨其结果的相关性。方法应用视频头脉冲试验及冷热试验对151例常见外周性眩晕患者进行检查,统计其结果进行分析。结果151例患者包括良性阵发性位置性眩晕58例,前庭神经炎34例,梅尼埃病39例,突发性聋伴眩晕20例。良性阵发性位置性眩晕患者冷热试验(CT)阳性率17.2%,水平半规管视频头脉冲试验(vHIT)阳性率8.6%,总阳性率24.1%;前庭神经炎患者CT阳性率97.1%,水平半规管vHIT阳性率97.1%,总阳性率100%;梅尼埃病患者CT阳性率59.0%,水平半规管vHIT阳性率12.8%,总阳性率69.2%;突发性聋伴眩晕患者CT阳性率45.0%,水平半规管vHIT阳性率15.0%,总阳性率55.0%。按照患侧半规管轻瘫(CP)值将所有患者分为A组(CP≤25%,n=76),B组(25%50%,n=31),对各组患者患侧水平半规管vHIT增益值进行比较,结果显示三组患者患侧水平半规管增益值之间具有统计学差异(F=12.263 P=0.000)。两两比较提示,A组及B组患侧水平半规管vHIT增益值组间无统计学差异(P=0.114),而A组与C组(P=0.000)、B组与C组(P=0.002)患侧水平半规管vHIT增益值组间差异具有统计学意义。结论在外周性眩晕疾病中,CT检查CP值小于等于50%时,患侧水平半规管vHIT增益值基本正常,而当CP值大于50%时,患侧水平半规管vHIT增益值明显下降,异常率显著提高;原发性BPPV患者不建议行vHIT;VN患者建议尽早联合CT及vHIT检查,作为重要的早期诊断手段。

A Study on Correlation between Video Head Impulse Test and Caloric Test

Objective To report characteristics of video head impulse test(vHIT)and caloric test(CT)in peripheral vertigo diseases and their correlation.Methods vHIT and CT were conducted in 151 patients with peripheral vertigo diseases including benign paroxysmal positional vertigo(BPPV,n=58),vestibular neuritis(VN,n=34),Meniere's disease(MD,n=39)and sudden deafness with vertigo(SD,n=20),and the results were analyzed.Results The rate of abnormal CT was 17.2% and the rate of abnormal vHIT suggesting involvement of horizontal semicircular canal was 8.6%(24.1%combined)in patients with BPPV,97.1% and 97.1%(100% combined)in patients with VN,59.0% and 12.8%(69.2% combined)in patients with MD,and 45.0% and 15.0%(55.0% combined)in patients with SD,respectively.Based on the degree of canal paresis(CP)on the abnormal side,patients were divided into three groups,i.e.CP≤25%(group A),25%50%(group C),and vHIT gains for the horizontal semicircular canal were compared among the groups,which showed a significant inter-group difference(F=12.263,P=0.000),especially between group A and group C(P=0.000)and between group B and group C(P=0.002),although not between group A and group B(P=0.114),Conclusion In patients with peripheral vestibular diseases,vHIT gains of horizontal semicircular canal remain essentially normal when CP value is under 50%,but decrease significantly when CP is more than 50%.vHIT is not recommended for patients with idiopathic BPPV.A combined vHIT and CT examination is recommended for patients with early stage VN.