伴单侧外周前庭受损的头晕/眩晕患者的临床分析

摘要

Objective:To explore the etiology,clinical manifestations and relative risk factors of dizziness/vertigo in patients with unilateral peripheral vestibular dysfunction (UPVD).Methods:One hundred and forty-eight dizziness/vertigo patients with UPVD (UPVD group) and 187 healthy controls (control group) were enrolled.The clinical data of 2 groups were collected and analyzed.Multivariate logistic regression analysis was used to analyze the independent risk factors for dizziness/vertigo patients with UPVD.Results:Cases in UPVD group aged fiom 9 to 86 years,and female/male ratio was 2/1.74.3％ of the cases in UPVD presented dizziness and 25.7％ presented vertigo.23.0％ of them were primary UPVD and 77.0％ were secondary/concomitant UPVD.The causes for patients with primary UPVD included acute primary UPVD,episodic primary UPVD and chronic primary UPVD.The causes for patients with secondary/concomitant UPVD included benign paroxysmal positional vertigo,persistent postural-perceptual dizziness,possible labyrinthine apoplexy,possible chronic ischemic UPVD,possible inner ear ischemic episodic vestibular disorder,vestibular migraine,meniere disease,vestibular neuritis and labyrinthine concussion.Multivariate logistic regression analysis showed that hypertension and hyperlipidemia (P＜0.05) were independent risk factors for dizziness/vertigo patients with UPVD.Conclusion:Dizziness/vertigo patients with UPVD are often accompanied by atherosclerosis risk factors.It is difficult to make a etiological diagnosis.Most of them are found to be associated with benign paroxysmal positional vertigo,persistent postural-perceptual dizziness and possible labyrinthine apoplexy.%目的:探讨伴单侧外周前庭受损(UPVD)的头晕/眩晕患者的病因学、临床特征及相关危险因素.方法:连续收集我院神经科门诊就诊的伴UPVD的头晕/眩晕患者148例为病例组,同期收集我院健康体检门诊年龄、性别相匹配的187例健康人为对照组.收集2组研究对象的基线资料,分析伴UPVD的头晕/眩晕患者的病因及伴发疾病分布,应用多元Logistic回归分析伴UPVD的头晕/眩晕患者的独立危险因素.结果:148例伴UPVD的头晕/眩晕患者年龄9～86岁,男:女约为1:2.可以头晕(74.3％)或眩晕(25.7％)起病,分原发性(23.0％)和继发性/伴发性(77.0％).原发性伴UPVD的头晕/眩晕患者包括急性原发单侧前庭病、发作性原发单侧前庭病、慢性原发单侧前庭病;继发/伴发性伴UPVD的头晕/眩晕患者包括良性阵发性位置性眩晕、持续性姿势-感知性头晕、可能的迷路卒中、慢性缺血性单侧前庭病可能、内耳缺血性发作性前庭病变可能、前庭性偏头痛、梅尼埃病、前庭神经元炎及迷路震荡.多元Logistic回归分析提示高血压、高脂血症是伴UPVD的头晕/眩晕患者的独立危险因素(P＜0.05).结论:神经科门诊伴UPVD的头晕/眩晕患者常伴有动脉粥样硬化危险因素.病因诊断较为困难,病因不明最为多见,其次多因伴发良性阵发性位置性眩晕、持续性姿势-感知性头晕和可能的迷路卒中而就诊.