摘要
目的探讨联合应用前庭自旋转(Vestibular autorotation test,VAT)和冷热试验对早期梅尼埃病和前庭性偏头痛的临床鉴别诊断价值。方法选取24例早期梅尼埃病非急性发作期(Meniere disease,MD)患者和22例前庭性偏头痛(Vestibular migraine,VM)患者进行VAT和冷热试验检查,均为单耳发病,均先行VAT检测后行冷热试验。VAT检测观察水平增益、水平相移、垂直增益、垂直相移、非对称性5项参数,其中任意一项及以上异常即评定为前庭功能异常;后行冷热试验观察记录半规管轻瘫值(canal paresis,CP)和热气试验最大慢相角速度(SPVmax)。对两组患者的VAT和冷热试验的结果进行比较,分析统计学差异。结果 VAT结果显示24例MD组16例(66.7%)前庭功能异常,其中增益增高1例次、降低8例次,增益部分增高部分降低1例次,相移延迟有12例次,非对称性异常有5例次;22例VM组中12例(54.5%)前庭功能异常,其中增益增高6例次、降低1例次,相移延迟有10例次。两组数据比较,增益增高和降低检出率有统计学差异(P<0.05)。冷热试验显示24例MD组中CP阳性14例(58.3%),SPVmax均值10.5°±9.5°/S;22例VM组CP阳性4例(18.2%),SPVmax均值34.7°±17.9°/S。两组CP和SPVmax均值比较有显著统计学差异(P<0.05)。结论在两组疾病的非急性发作期,VAT测试提示MD患者以4~6 Hz增益降低,VM患者以2~4 Hz增益增高为主要特征;冷热试验提示MD患者多表现为单侧水平半规管功能减退,而VM患者表现为亢进或者正常;二者的结合具有高低频互补作用,可以提高早期MD和VM的鉴别诊断。
Abstract： Objective To explore the clinical value of vestibular autorotation test （VAT） and caloric test in the differential diagnosis of early Meniere＇ s disease （MD） and vestibular migraine （VM）. Methods VAT and caloric test were applied to 24 patients suffering from MD in the non-acute phase （ MD group） and 22 cases with VM （ VM group）. All patients in both groups undertook VAT followed by caloric test. The evaluated parameters in VAT included horizontal gain/ phase, vertical gain/phase and asymmetry. Any abnormality of the above-mentioned five parameters was defined as abnormal vestibular function. In caloric test, canal paresis （CP） and the maximum slow phase velocity （SPVmax） were recorded and calculated. CP≥25% was defined as positive. The result differences between the two groups were analyzedstatistically. Results VAT results revealed abnormal vestibular function in 16 cases （66.7%） in the MD group and 12 （54.5%） in the VM group. The difference of detection rate of abnormal vestibular function between both groups was statistical insignificance （P 〉0.05）. In the MD group, gain was found to be abnormal in 10 cases including one with increased gain and 8 with decreased gain, as well as one with partly increased and partly decreased gains in horizontal testing. Phase delay was detected in 12 cases, and abnormal asymmetry was observed in 5. In the VM group, gain was found to be abnormal in 7 cases including 6 with increased gain and 1 with decreased gain, and phase delay was observed in 10 cases. The difference of detection rate of abnormal gain between the two groups was statistically significant （P 〈 0.05）. Caloric test was abnormal in 14 cases （58.3%） in the MD group and 4 （ 18.2% ） in the VM group. The average SPVmax was 10.5 ：t： 9.5 °/S in the MD group and 34.7 ° 17.9 °/S in the VM group, respectively. The positive rate of CP between the two groups were significantly different （ P 〈 O. 05 ）, and the SPVmax in the MD groups was sig
作者
张小莉
钱晓云
刘晶
黄杰
赵宁
陈红
高下
ZHANG Xiao-li;QIAN Xiao-yun;LIU Jing;HUANG Jie;ZHAO Ning;CHEN Hong;GAO Xia(Department of Otolaryngology-Head and Neck Surgery,Affiliated Drum Tower Hospital of Nanfing University Medical School,Jiangsu Provincial Key Medical Discipline（Laboratory;Research Institute of Otolaryngology,Nanfing 210008,China)
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2018年第4期341-345,共5页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
基金
国家自然科学基金青年基金项目(81700913)
江苏省自然科学基金青年基金项目(BK20160125)
江苏省自然科学基金社会发展面上项目(BE2018605)
江苏省科教强卫工程项目(ZDXKB2016015)
关键词
梅尼埃病
前庭性偏头痛
前庭自旋转试验
冷热试验
眩晕
Menieres disease
Vestibular migraine
Vestibular autorotation test
Caloric test
Vertigo
