The characteristics of vestibular-evoked myogenic potentials in unilateral Meniere's disease patients at different clinical stages
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摘要: 目的 回顾性研究单侧梅尼埃病(MD)患者气导颈肌前庭诱发肌源性电位(cVEMP)和眼肌前庭诱发肌源性电位(oVEMP)的表现。方法 回顾2016年1月-2022年2月就诊的MD患者的临床测试结果，收集符合纳入和排除标准的单侧MD患者共87例。根据MD临床分期分为三组：1组(Ⅰ和Ⅱ期MD)19例，2组(Ⅲ期MD)50例，3组(Ⅳ期MD)18例。计算各组患耳VEMP引出率、患耳P1和N1潜伏期异常率、波间期异常率，以及双耳振幅不对称比(IAR)异常率，分析不同临床分期MD患耳VEMP结果分级(1级为正常，2、3、4级为异常且逐级递增)与纯音听阈平均值之间的相关性。结果 1组、2组和3组cVEMP引出率分别为84.2%、70.0%和33.3%(P < 0.05)，oVEMP引出率分别为63.2%、34.0%和16.7%(P < 0.05)；cVEMP的P1和N1潜伏期与波间期总异常率分别为21.1%、26.3%和24.6%，oVEMP的P1和N1潜伏期与波间期总异常率分别为15.6%、43.8%和3.1%；cVEMP结果中IAR异常率分别为6.7%、21.2%和33.3%(P>0.05)，oVEMP结果中IAR异常率分别为16.7%、23.1%和0%(P>0.05)。Ⅰ~Ⅳ期MD患耳cVEMP结果分级与纯音听阈平均值之间具有相关性(r=0.339，P < 0.01)。Ⅰ~Ⅳ期MD患耳oVEMP结果分级与纯音听阈平均值之间具有相关性(r=0.362，P < 0.01)。结论 伴随MD进展，患耳在听力损失加重的同时，球囊-前庭下神经与椭圆囊-前庭上神经通路的功能也逐渐减弱。Abstract: Objective This study was to retrospectively analyze the results of vestibular-evoked myogenic potentials(VEMP) in unilateral Meniere's disease(MD) patients.Methods The clinical assessment results of MD patients who visited the department between January 2016 to February 2022 were reviewed. Unilateral MD patients who met the inclusion and exclusion criteria were divided into three groups according to clinical stages, namely, group 1(stage Ⅰ+ stage Ⅱ), group 2(stage Ⅲ) and group 3(stage Ⅳ). The normal value data were used to investigate the incidence of abnormal P1 and N1 latencies, abnormal P1-N1 interwave latency, and abnormal interaural amplitude asymmetry ratio(IAR). Afterwards, considering all the above mentioned parameters, the VEMP result of each patient was graded into four levels(grade 1 means VEMP result is normal, grade 2, 3 and 4 means the VEMP result is abnormal in different degrees). The correlation between VEMP result level and pure tone average(PTA) of MD patients in different clinical stages was examined.Results The prevalence of cVEMP in three groups was 84.2%, 70.0% and 33.3%, respectively(P < 0.05). The prevalence of oVEMP in three groups was 63.2%, 34.0% and 16.7%, respectively(P < 0.05). The incidence of abnormal P1 latency, N1 letancy and P1-N1 interwave latency of cVEMP was 21.1%, 26.3% and 24.6%, respectively. The incidence of abnormal P1 latency, N1 latency and interwave latency of oVEMP was 15.6%, 43.8% and 3.1%, respectively. The incidence of abnormal cVEMP IAR in group 1, group 2 and group 3 was 6.7%, 21.2% and 33.3%, respectively(P>0.05). The incidence of abnormal IAR of oVEMP in group 1, group 2 and group 3 was 16.7%, 23.1% and 0, respectively(P>0.05). cVEMP and oVEMP result levels were significantly correlated with PTA(r=0.339, P < 0.01; r=0.362, P < 0.01), respectively.Conclusion With the progression of MD, the function of saccule-vestibular inferior nerve pathway and utricle-vestibular superior nerve pathway would deteriorate in the same way as hearing.
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表 1 MD患者基本信息
组别 性别/例 年龄/岁 患耳侧别/例 500、1000和2000 Hz纯音听阈平均值/dB HL 男 女 左耳 右耳 1组 6 13 42.95±12.82 9 10 24±11.00 2组 24 26 52.20±13.00 29 21 58±9.00 3组 6 12 59.61±11.46 11 7 81±11.49 合计 36 51 51.71±13.67 49 38 55±21.26 
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表 2 正常参考值上限
测试内容 P1/ms N1/ms 波间期/ms IAR cVEMP 18.90 27.62 10.20 0.26 oVEMP 18.45 12.32 7.15 0.30
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表 3 患耳cVEMP和oVEMP单独与均引出率
例(%) 组别 例数 cVEMP oVEMP cVEMP和oVEMP 1组 19 16(84.2) 12(63.2) 12(63.2) 2组 50 35(70.0) 17(34.0) 14(28.0) 3组 18 6(33.3) 3(16.7) 2(11.1) 合计 87 57(65.5) 32(36.8) 28(32.2)
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表 4 cVEMP和oVEMP的IAR异常率
组别 cVEMP oVEMP 双耳引出/例 异常-患耳减弱/例 异常-患耳增强/例 异常率/% 双耳引出/例 异常-患耳减弱/例 异常-患耳增强/例 异常率/% 1组 15 1 0 6.7 12 0 2 16.7 2组 33 7 0 21.2 13 2 1 23.1 3组 6 2 0 33.3 2 0 0 0 合计 54 10 0 18.5 27 2 3 18.5
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表 5 不同临床分期MD患者患耳cVEMP与oVEMP结果分级
例(%) 临床分期 cVEMP oVEMP 1级 2级 3级 4级 1级 2级 3级 4级 Ⅰ期 6(50.0) 3(25.0) 1(8.3) 2(16.7) 4(33.3) 4(33.3) 0(0.0) 4(33.3) Ⅱ期 1(14.3) 4(57.1) 0(0.0) 2(28.6) 2(28.6) 2(28.6) 0(0.0) 3(42.8) Ⅲ期 15(30.0) 16(32.0) 4(8.0) 15(30.0) 5(10.0) 10(20.0) 2(4.0) 33(66.0) Ⅳ期 2(11.1) 4(22.2) 0(0.0) 12(66.7) 1(5.6) 2(11.1) 0(0.0) 15(83.3)
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