CAJ | 학술논문

目的评估良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者半规管损伤与异位耳石的关系及其损伤频率特征.方法 BPPV患者214例,包括后半规管管石症(posterior semicircular canal canalithasis,PSC-Can) 107例,水平半规管管石症(horizontal semicircular canal canalithasis,HSC-Can) 80例,水平半规管嵴顶结石症(horizontal semicircular canal cupulolithiasis,HSC-Cup) 27例；其中合并有其他疾病者190例(88.8％),无合并疾病者24例(11.2％).三组患者均完成高频视频头脉冲试验(video head impulse test,vHIT)、中频摇头试验(head shaking test,HST)和低频冷热试验三项检查,以vHIT的增益值(vHIT gain,vHIT-G)、HST诱发摇头眼震(head shaking nystagmus,HSN)和冷热试验单侧半规管反应非对称值(unilateral weakness,UW)为指标,分析三组不同责任半规管BPPV患者的三项试验结果特点及其相互关系.结果所有BPPV患者vHIT、HST及冷热试验的阳性率分别为7.0％、24.3％和71.0％,相差比较明显,经x2检验,差异具有统计学意义(P值均＜0.05)；有和无合并疾病的两类BPPV患者上述三项试验的阳性率结果比较,差异无统计学意义(P值均＞0.05).三组BPPV患者每一项试验(vHIT、HST及冷热试验)结果进行组间比较,差异均无统计学意义(P值均＞0.05).三组BPPV患者各组内上述三项试验结果之间比较,差异均具有统计学意义(P值均为0.000).三组冷热试验单侧异常者UW值比较,差异无统计学意义(F=0.970,P=0.383).结论 BPPV多存在与椭圆囊病变同源的半规管损伤,该损伤主要发生在低频区,异位耳石不是其损伤的主要原因；中频HST和高频vHIT不宜用作BPPV半规管损伤的筛查项目.
목적 평고량성진발성위치성현훈(benign paroxysmal positional vertigo,BPPV)환자반규관손상여이위이석적관계급기손상빈솔특정.방법 BPPV환자214례,포괄후반규관관석증(posterior semicircular canal canalithasis,PSC-Can) 107례,수평반규관관석증(horizontal semicircular canal canalithasis,HSC-Can) 80례,수평반규관척정결석증(horizontal semicircular canal cupulolithiasis,HSC-Cup) 27례；기중합병유기타질병자190례(88.8％),무합병질병자24례(11.2％).삼조환자균완성고빈시빈두맥충시험(video head impulse test,vHIT)、중빈요두시험(head shaking test,HST)화저빈랭열시험삼항검사,이vHIT적증익치(vHIT gain,vHIT-G)、HST유발요두안진(head shaking nystagmus,HSN)화랭열시험단측반규관반응비대칭치(unilateral weakness,UW)위지표,분석삼조불동책임반규관BPPV환자적삼항시험결과특점급기상호관계.결과 소유BPPV환자vHIT、HST급랭열시험적양성솔분별위7.0％、24.3％화71.0％,상차비교명현,경x2검험,차이구유통계학의의(P치균＜0.05)；유화무합병질병적량류BPPV환자상술삼항시험적양성솔결과비교,차이무통계학의의(P치균＞0.05).삼조BPPV환자매일항시험(vHIT、HST급랭열시험)결과진행조간비교,차이균무통계학의의(P치균＞0.05).삼조BPPV환자각조내상술삼항시험결과지간비교,차이균구유통계학의의(P치균위0.000).삼조랭열시험단측이상자UW치비교,차이무통계학의의(F=0.970,P=0.383).결론 BPPV다존재여타원낭병변동원적반규관손상,해손상주요발생재저빈구,이위이석불시기손상적주요원인；중빈HST화고빈vHIT불의용작BPPV반규관손상적사사항목.
Objective To assess the characteristics of the dysfunction of semicircular canal in benign paroxysmal positional vertigo and the relationship with the ectopic otoconia.Methods There were 214 patients with benign paroxysmal positional vertigo( BPPV),including 107 cases of posterior semicircular canal canalithasis(PSC-Can) 80 cases of horizontal semicircular canal canalithasis( HSC-Can),27 cases of horizontal semicircular canal cupulolithiasis (HSC-Cup).One hundred and ninety (88.8％)patients were accompany with relevant diseases while 24 ( 11.2％ ) cases were not.They accepted low,middle and high frequency vestibular function tests,including caloric test ( CT),head shaking test (HST) and video head impulse test(vHIT) respectively.The parameters of the unilateral weakness(UW),head shaking nystagmus (HSN) and video head impulse test gain(vHIT-G) were observed.Patients classified into three groups (PSC-Can,HSC-Can,HSC-Cup) according to the involvement semicircular canal.The results of the three tests were analyzed with SPSS16.0 software.Results The positive cases of the three tests were vHIT:15 (7.0％),HST:52(24.3％ ),CT:152(71.0％ ),a statistically significant difference(P ＜ 0.05) was found between the three tests.When compared the Calorie Test,HST and vHIT between the BPPV patients with and without relevant diseases,there were no significant differences ( P ＞ 0.05 ).The variance without statistical significance(P ＞ 0.05) was showed between three tests' results in each groups,it was also showed that the variance between the three groups in each tests reached no statistical significance(P ＞0.05 ).The test of affected side UW between PSC-Can,HSC- Can and HSC-Cup showed the variance without statistical significance( F =0.970,P =0.383 ). Conclusions The lesion of semicircular canals has the same etiological factors with the utricle pathological change in benign paroxysmal positional vertigo,and the dysfunction mostly happens in low frequency range of semicircular canal frequency band. The ectopic otoconia is not the main etiological factors for that.HST and vHIT of middle and high frequency can not be ultimately used for the screening test evaluating due to the semicircular canal function in BPPV.