抑制性头脉冲试验范式在临床前庭测试中的应用：一项以解读为重点的叙述性综述

文献信息

中文摘要

抑制性头脉冲试验（SHIMP）是一种视频头脉冲试验范式，其中视觉目标固定于头部。由于头脉冲刺激与传统头脉冲范式（HIMP；目标固定于地球）相同，这两种范式提供互补信息：HIMP主要通过代偿性追赶性扫视揭示前庭功能减退，而SHIMP在健康个体中诱发脉冲后抗代偿性“重捕获”扫视，因此能够突出残余前庭驱动以及前庭-扫视相互作用的完整性。自首次临床描述以来，SHIMP已应用于单侧和双侧前庭疾病，并且最近应用于选定的中枢神经系统疾病。然而，不同实验室和设备之间的解读仍存在差异，并且可能受到可预测刺激、早期扫视、隐性替代策略以及急性前庭丧失后相位依赖性变化的干扰。本叙述性综述聚焦于一个解读框架，该框架明确区分（i）前庭驱动（慢相前庭眼反射和增益）与（ii）重新注视任务定义目标所需的扫视策略。本综述综合了SHIMP与HIMP相比反向扫视特征的生理学原理，提出了一套术语，并提供了实用的解读规则及关键亚病例（急性与随访期单侧前庭丧失；伴有“不适当”隐性扫视的双侧前庭病；中枢疾病中功能性增益的SHIMP阴性模式）。重点在于波形轨迹级检查和纵向、情境感知的增益与扫视指标解读。

英文摘要

Suppression head impulse test (SHIMP) is a video head impulse test paradigm in which the visual target is head-fixed. Because the head impulse stimulus is identical to the conventional head impulse paradigm (HIMP; earth-fixed target), the 2 paradigms provide complementary information: HIMP primarily reveals vestibular hypofunction through compensatory catch-up saccades, whereas SHIMP elicits post-impulse anti-compensatory "recapture" saccades in healthy individuals and can therefore highlight residual vestibular drive and the integrity of the vestibulo-saccadic interaction. Since its first clinical description, SHIMP has been applied across unilateral and bilateral vestibular disorders and, more recently, in selected central nervous system conditions. However, interpretation remains variable between laboratories and devices and can be confounded by predictable stimulation, early saccades, covert substitution strategies, and phase-dependent changes after acute vestibular loss. This narrative review focuses on an interpretation framework that explicitly separates (i) vestibular drive (slow-phase vestibulo-ocular reflex and gain) from (ii) the saccadic strategy required to re-foveate the task-defined target. The review synthesizes the physiological rationale for the reversed saccadic signature of SHIMP versus HIMP, proposes a terminology set, and provides practical interpretation rules with key sub-cases (acute versus follow-up unilateral vestibular loss; bilateral vestibulopathy with "inappropriate" covert saccades; SHIMP-negative patterns with functional gain in central disorders). Emphasis is placed on trace-level waveform inspection and longitudinal, context-aware reading of gain and saccade metrics.