持续性姿势-知觉性头晕中的神经递质调控网络：潜在机制与治疗意义。

文献信息

中文摘要

持续性姿势-知觉性头晕（PPPD）是一种慢性功能性前庭障碍，其特征为持续的非旋转性头晕、主观不稳感，以及由直立姿势、运动和复杂视觉运动诱发的症状加重。异常的前庭感觉重加权、视觉依赖性增加、姿势过度警觉以及共病焦虑被认为促成了症状的持续存在。神经递质系统，包括5-羟色胺、去甲肾上腺素、多巴胺、γ-氨基丁酸、谷氨酸、组胺、乙酰胆碱和神经肽，可能通过调节前庭信号处理、情绪反应和中枢代偿，参与疾病相关的神经网络失衡。然而，针对PPPD特异性神经递质异常的直接证据仍然有限。在治疗方面，选择性5-羟色胺再摄取抑制剂和5-羟色胺-去甲肾上腺素再摄取抑制剂在临床实践中常被使用，但来自安慰剂对照随机试验的证据仍不充分。前庭与平衡康复治疗、认知行为治疗以及经颅磁刺激可被纳入综合管理；然而，不同干预措施的证据水平和长期疗效存在差异。未来研究应整合临床表型、共病和神经网络特征，以制定分层诊断和治疗策略，同时加强神经递质相关影像学、生物标志物发现和多中心随机对照试验。

英文摘要

Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder characterized by persistent non-spinning dizziness, subjective unsteadiness, and symptom exacerbation induced by upright posture, movement, and complex visual motion. Abnormal vestibular sensory reweighting, increased visual dependence, postural hypervigilance, and comorbid anxiety are considered to contribute to the persistence of symptoms. Neurotransmitter systems, including serotonin, norepinephrine, dopamine, gamma-aminobutyric acid, glutamate, histamine, acetylcholine and neuropeptides, may participate in the disease-related neural network imbalance by modulating vestibular signal processing, emotional responses, and central compensation. However, direct evidence for PPPD-specific neurotransmitter abnormalities remains limited. In treatment, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are commonly employed in clinical practice, yet evidence from placebo-controlled randomized trials remains insufficient. Vestibular and balance rehabilitation therapy, cognitive behavioral therapy, and transcranial magnetic stimulation may be incorporated into comprehensive management; however, the level of evidence and long-term efficacy differ across interventions. Future studies should integrate clinical phenotypes, comorbidities, and neural network features to develop stratified diagnostic and therapeutic strategies, while also strengthening neurotransmitter-related imaging, biomarker discovery, and multicenter randomized controlled trials.