Diagnostic value of RART and LDT in determining the affected semicircular canal for the HSC-BPPV
-
摘要: 目的 评价快速轴位滚转试验(rapid axial roll test，RART)、传统滚转试验(supine roll test，SRT)与坐-卧位试验(lying-down test，LDT)在水平半规管良性阵发性位置性眩晕(horizontal semicircular canal benign paroxysmal positional vertigo，HSC-BPPV)责任半规管定侧诊断中的价值。 方法 收集2022年9月-2023年9月确诊为HSC-BPPV的患者330例，根据不同位置性试验分为①SRT组；②LDT+SRT组；③RART+SRT组。②③组试验分为2个阶段，第一阶段患者进行LDT/RART，第二阶段进行SRT试验。比较3组患者的眼震引出率，评价其对HSC-BPPV责任半规管定侧的准确性。 结果 330例HSC-BPPV患者眼震总引出率为84.55%(279/330)，RART+SRT组的眼震引出率为94.55%(104/110)，LDT+SRT组的眼震引出率为84.11%(90/107)，SRT组的眼震引出率为69.91%(79/113)，3组差异有统计学意义(χ2=23.884，P＜0.001)；②③组患者均分为2个阶段进行试验，第一阶段患者进行LDT或RART，2组间眼震引出率差异有统计学意义(χ2=43.842，P＜0.001)；第二阶段进行SRT，2组间眼震引出率差异有统计学意义(χ2=4.690，P=0.030)。比较2组患者第一阶段LDT或RART和第二阶段SRT在判断半规管患侧方面的一致性比例，2组间差异有统计学意义(χ2=40.502，P＜0.001)。采用Kappa一致性检验发现RART与SRT在眼震引出率方面具有高度一致性(一致率达96.36%，Kappa=0.730，P＜0.001)。 结论 RART与SRT在眼震引出率方面具有高度一致性，且RART操作简单、安全，可有效诱导出HSC-BPPV特征性眼震，准确识别责任半规管，为HSC-BPPV的临床实践提供更优化的检查方案。
-
关键词:
- 快速轴位滚转试验 /
- 坐-卧位试验 /
- 水平半规管良性阵发性位置性眩晕 /
- 责任半规管 /
- 眼震引出率
Abstract: Objective To evaluate the utility of the Rapid Axial Roll Test (RART), Supine Roll Test (SRT), and Lying-Down Test (LDT) in determining the affected semicircular canal in cases of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV). Methods A total of 330 patients diagnosed with HSCBPPV from September 2022 to September 2023 were collected and divided into three groups based on the different positional tests received: ①SRT Group, ②LDT+SRT Group, ③RART+SRT Group. The trial was divided into two stages: LDT/RART for patients in the first stage, and SRT for patients in the second stage. The elicitation rate of nystagmus among the three groups was compared to evaluate the accuracy in determining the affected semicircular canal in HSCBPPV. Results Nystagmus was elicited in 84.55% (279/330) of the patients by positional tests. The elicitation rate of nystagmus in the RART+SRT/LDT group was 94.55% (104/110), in the LDT+SRT group it was 84.11% (90/107), and in the SRT group it was 69.91% (79/113). The differences among the three groups were statistically significant (χ2= 23.88, P < 0.001). In the ② and ③ groups, there was a statistically significant difference in the elicitation rate of nystagmus between stage Ⅰ (patients with LDT or RART) (χ2=43.842, P < 0.001). SRT was performed in the stage Ⅱ, and there was a statistically significant difference in nystagmus extraction rate between the two groups (χ2 =4.690, P=0.030). The difference in the proportion of agreement between stage Ⅰ(LDT or RART) and stageⅡ (SRT) in determining the affected side of the semicircular canal was also statistically significant (χ2 =40.502, P < 0.001). For patients with a consistent diagnosis of the affected semicircular canal, the difference in cure rate was not significant (P=0.149). The Kappa statistic indicated substantial agreement between RART and SRT in terms of eliciting nystagmus (agreement 96.36%, Kappa = 0.730, P < 0.001). Conclusion RART and SRT show a high degree of agreement regarding the elicitation rate of nystagmus. RART is simple and safe, and it can effectively induce the characteristic nystagmus of HSC-BPPV, accurately identify the responsible semicircular canal and provide a more optimized examination protocol for clinical practice in HSCBPPV. -
-
表 1 HSC-BPPV患者基本特征
例(%) 基本特征 例数(n=330) SRT(n=113) LDT+SRT(n=107) RART+SRT(n=110) χ2 P 性别 3.970 0.137 男 114(34.5) 42(37.2) 29(27.1) 43(39.1) 女 216(65.5) 71(62.8) 78(72.9) 67(60.9) 年龄 2.436 0.296 ＜40岁 53(16.1) 23(20.4) 14(13.1) 16(14.5) ≥40岁 277(83.9) 90(79.6) 93(86.9) 94(85.5) 体重指数 1.338 0.512 ＜24 kg/m2 134(40.6) 45(39.8) 48(44.9) 41(37.3) ≥24 kg/m2 196(59.4) 68(60.2) 59(55.1) 69(62.7) 病程 2.505 0.644 ≤7 d 110(33.3) 32(28.3) 41(38.3) 37(33.6) ＞7~＜30 d 145(43.9) 53(46.9) 44(41.1) 48(43.6) ≥30 d 75(22.7) 28(24.8) 22(20.6) 25(22.7) 
下载: 导出CSV
表 2 3组患者眼震引出率结果
组别 例数 引起眼震 眼震引出率/% χ2 P SRT组 113 79 69.91 LDT+SRT组 107 90 84.11 23.884 ＜0.001 RART+SRT组 110 104 94.55 合计 330 273 82.73
下载: 导出CSV
表 3 2组LDT/RART与SRT比较
例(%) 组别 LDT/RART眼震引出率 SRT眼震引出率 责任半规管判定的一致性比例 痊愈率 LDT+SRT 55(51.40) 89(83.18) 50(46.73) 47(94.00) RART+SRT 101(91.82) 102(92.73) 96(87.27) 94(97.92) χ2 43.842 4.690 40.502 2.083 P ＜0.001 0.030 ＜0.001 0.149
下载: 导出CSV
表 4 LDT/RART与SRT在眼震引出率中一致性的比较
例(%) 方法 SRT 一致率/% Kappa P (+) (-) LDT (+) 52(48.60) 3(2.80) 64.49 0.277 ＜0.001 (-) 35(32.71) 17(15.89) RART (+) 100(90.91) 2(1.82) 96.36 0.730 ＜0.001 (-) 2(1.82) 6(5.45)
下载: 导出CSV
-
[1] Strupp M, Mandala M, Vinck AS, et al. The semont-plus maneuver or the epley maneuver in posterior canal benign paroxysmal positional Vertigo: a randomized clinical study[J]. JAMA Neurol, 2023, 80(8): 798-804. doi: 10.1001/jamaneurol.2023.1408
[2] 金昕, 孔维佳, 冷杨名, 等. 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.
[3] Imai T, Inohara H. Benign paroxysmal positional Vertigo[J]. Auris Nasus Larynx, 2022, 49(5): 737-747. doi: 10.1016/j.anl.2022.03.012
[4] 蔡秋颖, 张丹, 孙贺. 水平半规管良性阵发性位置性眩晕责任半规管判定的策略[J]. 中国冶金工业医学杂志, 2023, 40(3): 263-265.
[5] Koju G, Bing D, Zhou LQ, et al. Comparisons of supine roll test and alternative positional tests in HC-BPPV lateralization[J]. Curr Med Sci, 2022, 42(3): 613-619. doi: 10.1007/s11596-022-2562-z
[6] 武斐, 邢轶卓, 毕巍, 等. 低头位及坐-卧位诱发眼震对HSC-BPPV患侧定位诊断的意义[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(2): 106-109. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2019.02.004
[7] 王秋敏, 刘萱, 马丽华, 等. 摇头后Supine roll试验对水平半规管良性阵发性位置性眩晕诊断的意义[J]. 听力学及言语疾病杂志, 2019, 27(3): 329-330.
[8] Chen ZW, Liu YJ, Lin CX, et al. Altered parietal operculum cortex 2 functional connectivity in benign paroxysmal positional Vertigo patients with residual dizziness: a resting-state fMRI study[J]. CNS Neurosci Ther, 2024, 30(2): e14570.
[9] Cohen HS, Stitz J, Sangi-Haghpeykar H, et al. Utility of quick oculomotor tests for screening the vestibular system in the subacute and chronic populations[J]. Acta Otolaryngol, 2018, 138(4): 382-386.
[10] Nuti D, Vannucchi P, Pagnini P. Benign paroxysmal positional vertigo of the horizontal canal: a form of canalolithiasis with variable clinical features[J]. J Vestib Res, 1996, 6(3): 173-184. doi: 10.3233/VES-1996-6303
[11] 邢娟丽, 张婷, 张姝, 等. 快速轴位滚转试验对水平管良性阵发性位置性眩晕定位诊断的意义[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(6): 419-422.
[12] Ling X, Zhao DH, Shen B, et al. Clinical characteristics of patients with benign paroxysmal positional Vertigo diagnosed based on the diagnostic criteria of the Bárány society[J]. Front Neurol, 2020, 11: 602. doi: 10.3389/fneur.2020.00602
[13] 员艳宁, 杨盼, 赵瀚森, 等. SRM眩晕诊疗系统中Barbecure联合Epley对HC-BPPV残余症状影响的研究[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(10): 786-789, 795. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2023.10.004
[14] 吴兢, 邹忆怀, 徐雯琰, 等. 改良翻滚法对水平半规管良性阵发性位置眩晕的疗效观察[J]. 北京医学, 2023, 45(8): 662-665.
[15] Choi SY, Oh SW, Kim HJ, et al. Determinants for bedside lateralization of benign paroxysmal positional Vertigo involving the horizontal semicircular canal[J]. J Neurol, 2020, 267(6): 1709-1714. doi: 10.1007/s00415-020-09763-x
[16] 邢娟丽, 张姝, 赵瀚森, 等. SRM眩晕诊疗系统中增加滚转试验对水平半规管良性阵发性位置性眩晕疗效的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(4): 268-271.
[17] Yetiser S, Ince D. Diagnostic role of head-bending and lying-down tests in lateral canal benign paroxysmal positional Vertigo[J]. Otol Neurotol, 2015, 36(7): 1231-1237.
[18] Martellucci S, Malara P, Castellucci A, et al. Upright BPPV protocol: feasibility of a new diagnostic paradigm for lateral semicircular canal benign paroxysmal positional Vertigo compared to standard diagnostic maneuvers[J]. Front Neurol, 2020, 11: 578305.
[19] 邢娟丽, 杨盼, 任瑞, 等. 体重指数对水平半规管良性阵发性位置性眩晕复位治疗效果的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(11): 869-871, 874. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2022.11.012
[20] Zuma E Maia F, Ramos BF, Cal R, et al. Management of lateral semicircular canal benign paroxysmal positional Vertigo[J]. Front Neurol, 2020, 11: 1040.
-
计量
- 文章访问数: 144
- 施引文献: 0