甲状旁腺功能亢进与眩晕：一项流行病学评估

文献信息

中文摘要

目的： 确定甲状旁腺功能亢进中良性阵发性位置性眩晕和其他眩晕状况的患病率和比值比。
研究设计： 2018年1月1日至2023年12月31日的分析性横断面研究。
地点： 单机构三级护理中心。
方法： 通过基于人群的样本，使用ICD-10诊断代码对患有原发性或继发性甲状旁腺功能亢进的成人进行分析。主要结局包括原发性和继发性甲状旁腺功能亢进中良性阵发性位置性眩晕和其他眩晕状况的患病率。次要结局包括原发性与继发性甲状旁腺功能亢进中良性阵发性位置性眩晕和其他眩晕状况的比值比，以及在维生素D缺乏情况下进一步系统性钙失调的比值比。
结果： 共纳入839名原发性甲状旁腺功能亢进受试者和1418名继发性甲状旁腺功能亢进受试者。原发性甲状旁腺功能亢进中良性阵发性位置性眩晕的患病率为每100人35.76例，高于一般人群（P = .01）。总体而言，甲状旁腺功能亢进中眩晕状况的诊断频率与肾结石病相当。继发性甲状旁腺功能亢进中良性阵发性位置性眩晕的患病率与一般人群相比无统计学差异，然而，未特指的眩晕诊断远比原发性甲状旁腺功能亢进中常见（P = .006）。在诊断为维生素D缺乏的受试者中，良性阵发性位置性眩晕和其他眩晕状况更常见。
结论： 原发性甲状旁腺功能亢进是眩晕/良性阵发性位置性眩晕的危险因素。甲状旁腺功能亢进，无论是原发性还是继发性疾病，都可能对耳石造成破坏。需要进一步研究以理解这种关系。对良性阵发性位置性眩晕危险因素的更好理解提供了对病理生理机制的额外见解。

英文摘要

OBJECTIVE: To determine the prevalence and odds ratios for benign paroxysmal positional vertigo and other dizziness conditions in hyperparathyroidism.
STUDY DESIGN: Analytical cross-sectional study from January 1, 2018, through December 31, 2023.
SETTING: Single-institution tertiary care center.
METHODS: Adults with primary or secondary hyperparathyroidism were analyzed through a population-based sample using ICD-10 diagnostic codes. The primary outcome included prevalence rates for benign paroxysmal positional vertigo and other dizziness conditions in primary and secondary hyperparathyroidism. Secondary outcomes consisted of odds ratios for benign paroxysmal positional vertigo and other dizziness conditions in primary versus secondary hyperparathyroidism, and with further systemic calcium dysregulation in the setting of vitamin D deficiency.
RESULTS: 839 primary hyperparathyroidism and 1418 secondary hyperparathyroidism subjects were included. The prevalence of benign paroxysmal positional vertigo was 35.76 per 100 individuals in primary hyperparathyroidism, higher than in the general population (P = .01). Collectively, dizziness conditions were diagnosed as frequently in hyperparathyroidism as nephrolithiasis. The prevalence of benign paroxysmal positional vertigo did not statistically vary in secondary hyperparathyroidism from the general population, however, unspecified dizziness diagnoses were far more common than in primary hyperparathyroidism (P = .006). Benign paroxysmal positional vertigo and other dizziness conditions were more likely in subjects with vitamin D deficiency diagnosis.
CONCLUSION: Primary hyperparathyroidism is a risk factor for vertigo/benign paroxysmal positional vertigo. Hyperparathyroidism, both in primary and secondary disease, may be disruptive to otoconia. Further research is needed to understand this relationship. Improved understanding of risk factors for benign paroxysmal positional vertigo offers additional insight into the pathophysiologic mechanisms.