视频头脉冲试验评估突发性聋伴眩晕患者的前庭上下神经损伤范围

摘要

目的 探讨视频头脉冲试验(video head impulse test,vHIT)在评估突发性聋伴眩晕患者前庭上下神经功能中的应用价值.方法 健康志愿者60例(120耳)为对照组,突聋伴眩晕患者182例(182耳)为实验组.对照组仅进行vHIT检查,实验组行vHIT和冷热试验检查;以vHIT的增益(video head impulse test-gain,vHIT-G)和冷热试验诱发眼震的非对称值(unilateral weakness,UW)作为观察指标,评估前庭上、下神经属区的功能,应用SPSS17.0统计软件进行数据分析.结果 对照组双侧前、水平和后半规管平均vHIT-G分别为(15.20±11.00)％、(15.30±13.30)％和(15.15±14.72)％,均呈正态分布,方差分析,相互间差异无统计学意义(F =0.005,P=1.000).突聋伴眩晕患者(实验组)患耳前、水平和后半规管平均vHIT-G分别为(21.73±14.84)％、(21.20±28.24)％和(19.22±23.50)％,与对照组相应半规管vHIT-G比较,差异均有统计学意义(P值均＜0.05).实验组vHIT与冷热试验的阳性率分别为26.9％(49/182)和70.3％(128/182),两者比较,差异有统计学意义(P＜0.05).根据vHIT结果判定,前庭上、下神经区均受累者15例(8.2％),单纯前庭上神经区受累19例(10.4％),单纯前庭下神经区受累15例(8.2％);而结合冷热试验结果综合判定,前庭上、下神经区均受累者29例(15.9％),单纯前庭上神经区受累101例(55.5％),单纯前庭下神经区受累1例(0.5％).结论 vHIT可以分别测评六个半规管的高频区功能,反映前庭上、下神经属区的高频病损情况,结合冷热试验可以更加全面地评估突聋伴眩晕患者的前庭损伤范围.%Objective To discuss the video head impulse tests (vHIT) application values in assessment of the vestibular nerves,function in sudden deafness patients with vertigo.Methods There were 60 cases(120 ears) of healthy volunteers as control group,and 182 cases(182 ears) of sudden deafness with vertigo patients as study group.The study group received vHIT and caloric test,and the control group received vHIT.Functions of vestibular superior and inferior nerves were analyzed by the gains of vHIT and the nystagmus,s unilateral weakness of caloric test,with SPSS17.0 software.Results The values of vHIT-G of the six semicircular canals in the control group were normal distribution and no statistical significance among them(F =0.005,P =1.000).The vHIT-G averages of both sides of anterior,horizontal and posterior semicircular canals were (15.20 ± 11.00) ％,(15.30 ± 13.30) ％,and (15.15 ± 14.72) ％ respectively.In the study group,the vHIT-G of the affected side were (21.73 ± 14.84)％,(21.20 ± 28.24)％,and (19.22 ± 23.50)％,with normal distribution,and in which statistical significance was detected comparing with those in the control group (P ＜ 0.05).The positive rates were 26.9％ (49/182) in vHIT,70.3％ (128/182) in caloric test.Significant difference (P ＜ 0.05) was observed between vHIT and caloric test examined by chi-square test.According to the results of vHIT,there were 15 cases (8.2％) damaged vestibular superior and inferior nerves areas,19 cases(10.4％) damaged the superior vestibular nerve area,and 15 cases(8.2％) damaged the inferior vestibular nerve area.In combination with caloric test results,it was shown that there were 29 cases(15.9％)damaged vestibular superior and inferior nerves areas,101 cases (55.5％)damaged the superior vestibular nerve area,and 1 case (0.5％)damaged the inferior vestibular nerve area.Conclusions vHIT can assess the function of six semicircular canals and illustrate high frequency of vestibular nerves.Caloric test combined with vHIT have more advantages to comprehensive assess vestibular damage of sudden deafness patients with vertigo.