The occurrence and evaluation methods of horizontal semicircular canal dysfunction in patients with common vestibular diseases
-
摘要: 目的 了解常见前庭疾病患者水平半规管功能损害的发生状况，探讨不同水平半规管评价手段的特性及临床价值。方法 回顾性分析2013年7月—2016年12月于大连医科大学附属第一医院眩晕专科门诊就诊且完成3种以上水平半规管功能检测，诊断为前庭性偏头痛(VM)、梅尼埃病(MD)、良性阵发性位置性眩晕(BPPV)、前庭神经炎(VN)的患者共396例及诊断不明患者104例，统计患者冷热试验(CT)、旋转试验(RT)、摇头眼震试验(HSN)及视频头脉冲试验(vHIT)的结果，计算不同检测手段的异常检出率，并以CT作为统计学的金标准评价各种检测手段的敏感性、特异性及符合率差异。结果 ① 4种评价手段异常率由高至低依次为HSN、CT、RT、vHIT(51.20%、50.80%、25.76%、19.74%)；②以CT作为金标准，在4种常见的前庭疾病中vHIT的敏感性为0.13~0.41、特异性为0.69~1.00，HSN的敏感性为0.44~0.76、特异性为0.29~0.69，RT的敏感性为0.25~0.45、特异性为0.50~0.84；③经统计学分析只有HSN与CT结果在4种疾病中差异无统计学意义，RT与CT在VM、BPPV中差异无统计学意义，而vHIT与CT结果只在BPPV中差异无统计学意义。结论 常见前庭疾病中HSN结果异常率最高，建议作为常规前庭功能筛查项目；vHIT的特异性较高值得推广；CT仍为水平半规管功能评价不可替代的手段。Abstract: Objective To understand the occurrence of horizontal semicircular canal functional impairment in patients with common vestibular diseases and to explore the characteristics and clinical value of different evaluation methods of horizontal semicircular canal.Methods From July 2013 to December 2016, patients who attended the vertigo clinic of the First Affiliated Hospital of Dalian Medical University and completed more than three horizontal semicircular canal function tests were retrospectively analyzed. A total of 396 patients diagnosed as vestibular migraine (VM), Ménière's disease (MD), benign paroxysmal positional vertigo (BPPV), vestibular neuritis (VN) and 104 patients with unknown diagnosis were enrolled. The results of caloric test (CT), rotation test (RT), head-shaking nystagmus test (HSN) and video head impulse test (vHIT) were collected and the abnormal detection rates of different detection methods were calculated. The sensitivity, specificity and coincidence rate of various detection methods were statistically analyzed using CT as the gold standard.Results ① The abnormal rates of the four evaluation methods from high to low were HSN, CT, RT, vHIT (51.20%, 50.80%, 25.76%, 19.74%, respectively); ②Taking CT as the gold standard, among these four common vestibular diseases, the sensitivity and specificity of vHIT were 0.13-0.41 and 0.69-1.00, the sensitivity and specificity of HSN were 0.44-0.76 and 0.29-0.69, and the sensitivity and specificity of RT were 0.25-0.45 and 0.50-0.84;③According to statistical analysis, only HSN and CT results showed no statistically significant difference in the 4 diseases. There was no significant difference between RT and CT in VM and BPPV, and vHIT and CT in BPPV.Conclusion The abnormal rate of HSN results in common vestibular diseases is highest, and it could be recommended as a routine vestibular function screening item. The specificity of vHIT is highest and worthy of promotion. CT is still an irreplaceable method to evaluate the function of horizontal semicircular canal.
-
-
表 1 4种检测水平半规管评价手段在不同疾病中的结果
疾病 CT RT HSN vHIT VM 正常/例 102 82 105 85 异常/例 81 21 78 15 异常率/% 44.26 20.39 42.62 15.00 MD 正常/例 36 53 39 46 异常/例 77 21 74 10 异常率/% 68.14 28.38 65.49 17.86 BPPV 正常/例 35 27 33 18 异常/例 16 6 18 6 异常率/% 31.37 18.18 35.29 25.00 VN 正常/例 7 20 12 12 异常/例 42 17 37 7 异常率/% 85.71 45.95 75.51 36.84 诊断不明 正常/例 66 63 55 22 异常/例 38 20 49 7 异常率/% 36.54 24.10 47.12 24.14 
下载: 导出CSV
表 2 以CT为金标准vHIT的敏感性、特异性和符合率
疾病 CT异常 CT正常 P值 敏感性 特异性 符合率/% 例数 % 例数 % VM(n=100) 11 28.95 4 6.45 < 0.001 0.29 0.94 69.00 MD(n=56) 9 24.32 1 5.26 < 0.001 0.24 0.95 48.21 BPPV(n=24) 1 12.50 5 31.25 0.774 0.13 0.69 50.00 VN(n=19) 7 41.18 0 0.00 0.002 0.41 1.00 47.37
下载: 导出CSV
表 3 以CT为金标准HSN的敏感性、特异性和符合率
疾病 CT异常 CT正常 P值 敏感性 特异性 符合率/% 例数 % 例数 % VM(n=183) 42 51.85 36 35.29 0.818 0.52 0.65 59.02 MD(n=113) 51 66.23 23 63.89 0.775 0.66 0.36 56.64 BPPV(n=51) 7 43.75 11 31.43 0.824 0.44 0.69 60.78 VN(n=49) 32 76.19 5 71.43 0.302 0.76 0.29 69.39
下载: 导出CSV
表 4 以CT为金标准RT的敏感性、特异性和符合率
疾病 CT异常 CT正常 P值 敏感性 特异性 符合率/% 例数 % 例数 % VM(n=103) 12 25.00 9 16.36 0.331 0.25 0.84 56.31 MD(n=74) 17 32.69 4 18.18 < 0.001 0.33 0.82 47.30 BPPV(n=33) 2 25.00 4 16.00 0.754 0.25 0.84 69.70 VN(n=37) 14 45.16 3 50.00 0.003 0.45 0.50 45.95
下载: 导出CSV
-
[1] 于立身. 前庭功能检查技术[M]. 北京: 人民军医出版社, 2012: 126-127, 147.
[2] Vallim M, Gabriel GP, Mezzalira R, et al. Does the video head impulse test replace caloric testing in the assessment of patients with chronic dizziness? A systematic review and meta-analysis[J]. Braz J Otorhinolaryngol, 2021, 87(6): 733-741. doi: 10.1016/j.bjorl.2021.01.002
[3] 中国医药教育协会眩晕专业委员会, 中国康复医学会眩晕与康复专业委员会, 中西医结合学会眩晕专业委员会, 等. 前庭功能检查专家共识(一)(2019)[J]. 中华耳科学杂志, 2019, 17(1): 117-123. doi: 10.3969/j.issn.1672-2922.2019.01.020
[4] Curthoys IS. The interpretation of clinical tests of peripheral vestibular function[J]. Laryngoscope, 2012, 122(6): 1342-1352. doi: 10.1002/lary.23258
[5] 中国医师协会神经内科医师分会疼痛和感觉障碍学组, 中国医药教育协会眩晕专业委员会, 中国研究型医院学会头痛与感觉障碍专业委员会. 前庭性偏头痛诊治专家共识(2018)[J]. 中国疼痛医学杂志, 2018, 24(7): 481-488. doi: 10.3969/j.issn.1006-9852.2018.07.001
[6] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会. 梅尼埃病诊断和治疗指南(2017)[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(3): 167-172. doi: 10.3760/cma.j.issn.1673-0860.2017.03.002
[7] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会. 良性阵发性位置性眩晕诊断和治疗指南(2017)[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(3): 173-177. doi: 10.3760/cma.j.issn.1673-0860.2017.03.003
[8] 中国医师协会神经内科分会眩晕专业委员会, 中国卒中学会卒中与眩晕分会, 李斐, 等. 前庭神经炎诊治多学科专家共识[J]. 中华老年医学杂志, 2020, 39(9): 985-994. doi: 10.3760/cma.j.issn.0254-9026.2020.09.001
[9] 刘秀丽, 杨军. 眩晕诊断学[M]. 北京: 科学出版社, 2020: 92-105.
[10] 莫江伟, 徐英, 石艳萍, 等. 视频头脉冲试验与冷热试验的相关性研究[J]. 中华耳科学杂志, 2021, 19(2): 252-257. doi: 10.3969/j.issn.1672-2922.2021.02.015
[11] 李姗姗, 韩曦, 王巍, 等. 前庭神经炎患者半规管损伤频率特征分析[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(3): 216-219.
[12] 袁庆, 李昕英, 张悦, 等. 前庭神经炎视频头脉冲测试结果的动态变化[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(11): 990-992, 998.
[13] Pérez P, Llorente JL, Gómez JR, et al. Functional significance of peripheral head-shaking nystagmus[J]. Laryngoscope, 2004, 114(6): 1078-1084. doi: 10.1097/00005537-200406000-00023
[14] Panichi R, Faralli M, Bruni R, et al. Asymmetric vestibular stimulation reveals persistent disruption of motion perception in unilateral vestibular lesions[J]. J Neurophysiol, 2017, 118(5): 2819-2832. doi: 10.1152/jn.00674.2016
[15] 吴子明, 任丽丽, 张素珍. 前庭功能筛查的必要性与迫切性[J]. 中华耳科学杂志, 2022, 20(1): 1-3.
[16] 杜丽平, 梁象逢, 区永康, 等. 前庭功能检查进展[J]. 中国眼耳鼻喉科杂志, 2007, 7(4): 262-263, 266. doi: 10.3969/j.issn.1671-2420.2007.04.037
[17] Cohen HS. A review on screening tests for vestibular disorders[J]. J Neurophysiol, 2019, 122(1): 81-92. doi: 10.1152/jn.00819.2018
[18] Du Y, Ren L, Liu X, et al. Machine learning method intervention: Determine proper screening tests for vestibular disorders[J]. Auris Nasus Larynx, 2022, 49(4): 564-570. doi: 10.1016/j.anl.2021.10.003
[19] MacDougall HG, McGarvie LA, Halmagyi GM, et al. A new saccadic indicator of peripheral vestibular function based on the video head impulse test[J]. Neurology, 2016, 87(4): 410-418. doi: 10.1212/WNL.0000000000002827
[20] Mekki S, Mohamed W, Omar S, et al. Caloric test versus videohead impulse test in vestibular neuritis patients[J]. Hearing Balance Communication, 2021, 19: 42-48. doi: 10.1080/21695717.2020.1727237
[21] Halmagyi GM, Chen L, MacDougall HG, et al. The Video Head Impulse Test[J]. Front Neurol, 2017, 8: 258. doi: 10.3389/fneur.2017.00258
-