视频头脉冲试验在周围性眩晕患者中的应用

doi:10.3785/j.issn.1008-9292.2017.02.08

浙江大学学报（医学版）

2017, Vol. 46

Issue (1): 52-58 DOI: 10.3785/j.issn.1008-9292.2017.02.08

原著

视频头脉冲试验在周围性眩晕患者中的应用

管琼峰^1,²(

),张力三¹,洪文轲²,杨怡¹,陈昭英²,张丹¹,胡兴越^1,^*(

)

⁽¹⁾ 浙江大学医学院附属邵逸夫医院神经内科, 浙江杭州 310020
⁽²⁾ 宁波市第二医院神经内科, 浙江宁波 315001

Video head impulse test for evaluation of vestibular function in patients with vestibular neuritis and benign paroxysmal positional vertigo

GUAN Qiongfeng^1,²(

),ZHANG Lisan¹,HONG Wenke²,YANG Yi¹,CHEN Zhaoying²,ZHANG Dan¹,HU Xingyue^1,^*(

)

⁽¹⁾ Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, China
⁽²⁾ Department of Neurology, Ningbo Second Hospital, Ningbo 315001, China

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摘要： 目的

探讨视频头脉冲试验（vHIT）评估前庭神经炎（VN）和良性发作性位置性眩晕（BPPV）患者前庭眼反射（VOR）的临床应用价值。

方法

收集2015年3月15日至9月10日在浙江大学医学院附属邵逸夫医院和宁波市第二医院诊断的33例VN患者和43例BPPV患者。另选同时段两家医院的工作人员、患者亲属以及社会志愿者50名作为健康对照组。用vHIT定量测定一对水平半规管平面、两对垂直半规管平面的VOR增益值及相应三个VOR增益不对称值并分析结果和差异，同时记录眼球追赶扫视信息。

结果

与健康对照组和BPPV组比较，VN组患侧水平及垂直VOR增益值减小，相应不对称值增大，差异均有统计学意义（均P < 0.01）；BPPV组每个VOR增益值及水平不对称值差异均无统计学意义（均P>0.05），垂直VOR增益不对称值增大（均P < 0.05）。与BPPV组比较，VN组患侧VOR增益值减小，相应三个不对称值增大，差异均有统计学意义（均P < 0.01）。vHIT早期诊断VN的敏感度为87.9%。33例VN患者中，除一例无法区分外，前庭上神经功能损害22例，前庭下神经功能损害7例，前庭上、下神经功能均损害3例。

结论

vHIT通过评估VN患者前庭功能可帮助临床早期诊断VN，具有良好的临床应用前景。

关键词： 前庭神经炎/诊断; 半规管; 眩晕/诊断; 眩晕/病因学; 体位; 反射, 前庭眼; 眼球运动; 前庭功能试验; 随机对照试验

Abstract: Objective

To assess the clinical application of video head impulse test (vHIT) for vestibular function in vestibular neuritis (VN) and benign paroxysmal positional vertigo (BPPV) patients.

Methods

Thirty-three patients with VN and 43 patients with BPPV were enrolled from Sir Run Run Shaw Hospital and Ningbo Second Hospital from March 15 to September 10, 2015; and 50 healthy controls were also enrolled in the study. vHIT was used to quantitatively test the vestibulo-ocular reflex (VOR) gains of a pair of horizontal semicircular canals. VOR gains two pairs of vertical semicircular canals, and the corresponding asymmetrical value of three VOR gains. The saccades information was also recorded.

Results

Compared with the healthy control group and BPPV patients, the affected horizontal and vertical VOR gains were declined and the corresponding asymmetries were increased in VN patients (all P < 0.01). BPPV group also showed higher vertical VOR gain asymmetries compared with the healthy control group (all P < 0.01), but no significant difference was observed in VOR gains and horizontal VOR gain asymmetry (all P>0.05). The sensibility of vHIT in diagnosis of VN was 87.9%. Among 33 VN patients, 22 were diagnosed with superior vestibular nerve dysfunction, 7 were found with inferior vestibular nerve dysfunction and 3 were with both dysfunction; and 1 case was not distinguished.

Conclusion

Video head impulse test can quantitatively evaluate the vestibular dysfunction of VN and can help early diagnosis of VN, which may be widely used in clinic.

Key words: Vestibular neuronitis/diagnosis Semicircular canals Vertigo/diagnosis Vertigo/etiology Posture Reflex, vestibulo-ocular Eye movements Vestibular function tests Randomized controlled trial

收稿日期: 2016-04-26 出版日期: 2017-07-06

CLC:

R764

基金资助: 浙江省医药卫生科技计划(2016KYB264)

通讯作者: 胡兴越 E-mail: guanqiongfeng@163.com;huxingyue2003@126.com

作者简介: 管琼峰 (1980-), 女, 硕士研究生, 主治医师, 主要从事眩晕症、帕金森病的诊治及A型肉毒毒素注射治疗; E-mail: guanqiongfeng@163.com|胡兴越 (1962-), 男, 博士, 主任医师, 主要从事脑血管疾病、肌张力障碍的诊治及A型肉毒毒素注射治疗. E-mail: huxingyue2003@126.com

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引用本文:

管琼峰,张力三,洪文轲,杨怡,陈昭英,张丹,胡兴越. 视频头脉冲试验在周围性眩晕患者中的应用[J]. 浙江大学学报（医学版）, 2017, 46(1): 52-58.

GUAN Qiongfeng,ZHANG Lisan,HONG Wenke,YANG Yi,CHEN Zhaoying,ZHANG Dan,HU Xingyue. Video head impulse test for evaluation of vestibular function in patients with vestibular neuritis and benign paroxysmal positional vertigo. J Zhejiang Univ (Med Sci), 2017, 46(1): 52-58.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2017.02.08 或 http://www.zjujournals.com/med/CN/Y2017/V46/I1/52

表1 三组受试者VOR定量结果比较

图1 视频头脉冲试验显示前庭神经炎单纯累及水平半规管功能损害图中心六条柱分别为六个半规管前庭眼反射增益值，绿色柱为正常，红色柱代表功能缺失；周围六小图分别记录六个半规管功能，包括头动曲线 (左侧蓝色、右侧紫色)、相应前庭眼反射曲线 (绿色) 以及追赶扫视 (红色).

图2 视频头脉冲试验显示前庭神经炎累及水平半规管及前半规管功能损害图中心六条柱分别为六个半规管前庭眼反射增益值，绿色柱为正常，红色柱代表功能缺失；周围六小图分别记录六个半规管功能，包括头动曲线 (左侧蓝色、右侧紫色)、相应前庭眼反射曲线 (绿色) 以及追赶扫视 (红色).

图3 视频头脉冲试验显示前庭神经炎累及后半规管功能损害图中心六条柱分别为六个半规管前庭眼反射增益值，绿色柱为正常，红色柱代表功能缺失；周围六小图分别记录六个半规管功能，包括头动曲线 (左侧蓝色、右侧紫色)、相应前庭眼反射曲线 (绿色) 以及追赶扫视 (红色).

图4 视频头脉冲试验显示前庭神经炎累及全组半规管功能损害图中心六条柱分别为六个半规管前庭眼反射增益值，绿色柱为正常，红色柱代表功能缺失；周围六小图分别记录六个半规管功能，包括头动曲线 (左侧蓝色、右侧紫色)、相应前庭眼反射曲线 (绿色) 以及追赶扫视 (红色).

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