-
摘要: 目的 研究双侧前庭病(BVP)在有走路不稳症状的门诊患者中的患病率, 并分析其临床特征。方法 依据BVP的常见病因, 检索2018年1月-2019年10月诊断为"走路不稳""梅尼埃病(双侧)""化疗复查""系统性红斑狼疮(SLE)"及"血管炎"的门诊患者共2075例, 通过电话访谈筛选出符合BVP典型表现的患者, 进一步完成问卷调查和视频头脉冲试验(vHIT)。结果 131例患者回电并诉慢性走路不稳, 双侧梅尼埃病、化疗、SLE及血管炎患者的应答率分别为10.0%, 0%, 0.3%及1.2%。走路不稳的症状在SLE、血管炎和化疗患者中的发生率较低或程度较轻。29例符合BVP典型表现的患者vHIT检查后仅有3例确诊。在老年人和男性患者中, 感到走路不稳对生活影响非常严重的患者水平前庭眼反射增益值均显著低于轻度-重度患者(均P < 0.01);而在年轻人和女性患者中, 两组间差异无统计学意义(P=0.396, 0.180)。结论 走路不稳门诊患者中BVP占2.3%, 症状典型的患者经vHIT检查后仅有10.3%符合诊断标准, 提示前庭功能检查在确诊中的重要性。Abstract: Objective This study aimed to find bilateral vestibulopathy(BVP) patients in outpatients with unsteadiness and investigate their clinical characteristics.Methods According to the common manifestation and etiologies of BVP, 2075 outpatients who were diagnosed as imbalance, follow up on chemotherapy, bilateral Menière's disease, systemic lupus erythematosus(SLE) and vasculitis from January 2018 to October 2019 were searched based on the hospital information system. After completing a telephone screening interview, eligible individuals whose symptoms were in consistent with the diagnostic criteria of BVP were scheduled for questionnaires and video head impulse test(vHIT).Results A total of 131 patients replied and complained chronic unsteadiness. The response rates of patients with bilateral Menière's disease, chemotherapy, SLE and vasculitis were 10.0%, 0%, 0.3% and 1.2%, respectively. Unsteadiness is uncommon or mild in outpatients with vasculitis, SLE and chemotherapy. Twenty-nine patients presented with typical symptoms of BVP and only 3 were diagnosed as BVP after vHIT. The horizontal vHIT gain was significantly lower among patients who reported very severe life impact than those reported mild to severe impact in older patients, as well as in male patients(both P < 0.01). However, no significant differences were noted in younger and female patients(P=0.396, 0.180, respectively).Conclusion BVP accounts for 2.3% in outpatients with unsteadiness, and only 10.3% of patients who presents with typical symptoms meet the diagnostic criteria, suggesting vestibular function test is of great significance in making diagnosis.
-
Key words:
- bilateral vestibulopathy /
- video head impulse test /
- prevalence
-
-
[1] Lucieer F, Duijn S, Van Rompaey V, et al. Full Spectrum of Reported Symptoms of Bilateral Vestibulopathy Needs Further Investigation-A Systematic Review[J]. Front Neurol, 2018, 9: 352. doi: 10.3389/fneur.2018.00352
[2] Guinand N, Boselie F, Guyot JP, et al. Quality of life of patients with bilateral vestibulopathy[J]. Ann Otol Rhinol Laryngol, 2012, 121(7): 471-477. doi: 10.1177/000348941212100708
[3] Strupp M, Kim JS, Murofushi T, et al. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society[J]. J Vestib Res, 2017, 27(4): 177-189. doi: 10.3233/VES-170619
[4] Zingler VC, Weintz E, Jahn K, et al. Causative factors, epidemiology, and follow-up of bilateral vestibulopathy[J]. Ann N Y Acad Sci, 2009, 1164: 505-508. doi: 10.1111/j.1749-6632.2009.03765.x
[5] Rinne T, Bronstein AM, Rudge P, et al. Bilateral loss of vestibular function: clinical findings in 53 patients[J]. J Neurol, 1998, 245(6/7): 314-321.
[6] Ward BK, Agrawal Y, Hoffman HJ, et al. Prevalence and impact of bilateral vestibular hypofunction: results from the 2008 US National Health Interview Survey[J]. JAMA Otolaryngol Head Neck Surg, 2013, 139(8): 803-810. doi: 10.1001/jamaoto.2013.3913
[7] Brandt T, Dieterich M. The dizzy patient: don't forget disorders of the central vestibular system[J]. Nat Rev Neurol, 2017, 13(6): 352-362. doi: 10.1038/nrneurol.2017.58
[8] Supuk E, Alderson A, Davey CJ, et al. Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes[J]. Ophthalmic Physiol Opt, 2016, 36(2): 183-190. doi: 10.1111/opo.12243
[9] Maurer MS, Burcham J, Cheng H. Diabetes mellitus is associated with an increased risk of falls in elderly residents of a long-term care facility[J]. J Gerontol A Biol Sci Med Sci, 2005, 60(9): 1157-1162. doi: 10.1093/gerona/60.9.1157
[10] Lucieer F, Vonk P, Guinand N, et al. Bilateral Vestibular Hypofunction: Insights in Etiologies, Clinical Subtypes, and Diagnostics[J]. Front Neurol, 2016, 7: 26.
[11] Wester JL, Ishiyama A, Ishiyama G. Recurrent Vestibular Migraine Vertigo Attacks Associated With the Development of Profound Bilateral Vestibulopathy: A Case Series[J]. Otol Neurotol, 2017, 38(8): 1145-1148. doi: 10.1097/MAO.0000000000001486
[12] Ji L, Zhai S. Aging and the peripheral vestibular system[J]. J Otol, 2018, 13(4): 138-140. doi: 10.1016/j.joto.2018.11.006
[13] Mukherjea D, Rybak LP. Pharmacogenomics of cisplatin-induced ototoxicity[J]. Pharmacogenomics, 2011, 12(7): 1039-1050. doi: 10.2217/pgs.11.48
[14] McGarvie LA, MacDougall HG, Halmagyi GM, et al. The Video Head Impulse Test(vHIT)of Semicircular Canal Function-Age-Dependent Normative Values of VOR Gain in Healthy Subjects[J]. Front Neurol, 2015, 6: 154.
[15] Jahn K, Freiberger E, Eskofier BM, et al. Balance and mobility in geriatric patients: Assessment and treatment of neurological aspects[J]. Z Gerontol Geriatr, 2019, 52(4): 316-323. doi: 10.1007/s00391-019-01561-z
[16] 林颖, 高林溪, 李琳, 等. 双侧前庭病的病因及前庭功能评估[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(5): 379-382. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201805015.htm
-
下载:
图(2)
计量
- 文章访问数: 1084
- PDF下载数: 237
- 施引文献: 0