利用复杂视觉环境中的行为反应区分持续性姿势-知觉性头晕与焦虑障碍

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中文摘要

背景/目的： 持续性姿势-知觉性头晕（PPPD）与焦虑障碍（AD）具有重叠的临床特征，使得常规评估难以区分二者。本研究探讨基于虚拟现实（VR）的前庭评估和沉浸式恐惧场景是否能揭示这两种疾病之间不同的反应特征。方法：在这项初步、单中心、横断面研究中，32名参与者（PPPD：n = 15，AD：n = 17）接受了耳鼻咽喉科/听力学和精神科的联合评估，包括感觉交互与平衡临床试验-VR（CTSIB-VR）、稳定极限（LOS）、头晕残障量表（DHI）、贝克焦虑量表（BAI），以及两个沉浸式VR场景（CrowdVR和Supermarket Scrolling）。在每个场景后记录症状发作潜伏期、最大耐受强度、回避行为和场景后模拟器晕动病问卷（SSQ）评分。结果：两组在任何LOS参数上均无差异。PPPD组的CTSIB-VR视觉偏好显著更高（74.07 ± 7.44 vs. 60.82 ± 2.46，p < 0.001）。在CrowdVR和Supermarket Scrolling场景中，PPPD组的SSQ定向障碍评分显著升高（分别为p = 0.004和p = 0.002）；在基线VR暴露时，SSQ定向障碍显示出相同的方向性模式但未达到显著性（p = 0.069），基线时PPPD组的SSQ总严重程度评分在数值上更高（51.61 ± 17.62 vs. 41.13 ± 11.83），呈趋势水平（p = 0.055）。AD组的BAI总分明显更高（29.82 ± 4.86 vs. 19.27 ± 6.43，p < 0.001）。CrowdVR暴露期间PPPD组的症状发作潜伏期更长（中位数5.36 vs. 3.10分钟，p = 0.007），而AD组的回避行为更为明显（p = 0.027）。结论：PPPD和AD显示出不同的、探索性的基于VR的反应特征：PPPD以视觉依赖、耐受时间延长和更严重的定向障碍为特征，而AD则表现出更高的焦虑负担和更早的回避。这些初步的、产生假设的发现表明，基于场景的VR评估作为区分PPPD与焦虑障碍的辅助手段可能值得进一步研究，尚需在更大规模的多中心队列中进行诊断准确性验证。

英文摘要

Background/Objectives: Persistent postural-perceptual dizziness (PPPD) and anxiety disorder (AD) share overlapping clinical features that make differentiation with conventional assessments challenging. This study examined whether virtual reality (VR)-based vestibular assessment and immersive phobic scenarios can reveal distinct response profiles between these conditions. Methods: In this preliminary, single-center, cross-sectional study, 32 participants (PPPD: n = 15, AD: n = 17) underwent joint otorhinolaryngological/audiological and psychiatric evaluation, including the Clinical Test of Sensory Interaction and Balance-VR (CTSIB-VR), Limits of Stability (LOS), Dizziness Handicap Inventory (DHI), Beck Anxiety Inventory (BAI), and two immersive VR scenarios (CrowdVR and Supermarket Scrolling). Symptom onset latency, maximum tolerated intensity, avoidance behavior, and post-scenario Simulator Sickness Questionnaire (SSQ) scores were recorded after each scenario. Results: Groups did not differ on any LOS parameter. CTSIB-VR Visual Preference was significantly higher in the PPPD group (74.07 ± 7.44 vs. 60.82 ± 2.46, p < 0.001). SSQ Disorientation scores during the CrowdVR and Supermarket Scrolling scenarios were significantly elevated in PPPD (p = 0.004 and p = 0.002, respectively); at baseline VR exposure, SSQ Disorientation showed the same directional pattern but did not reach significance (p = 0.069), and the SSQ Total Severity score at baseline was numerically higher in PPPD (51.61 ± 17.62 vs. 41.13 ± 11.83) at a trend level (p = 0.055). BAI Total was markedly higher in the AD group (29.82 ± 4.86 vs. 19.27 ± 6.43, p < 0.001). Symptom onset latency during CrowdVR exposure was longer in PPPD (median 5.36 vs. 3.10 min, p = 0.007), whereas avoidance behavior was more pronounced in the AD group (p = 0.027). Conclusions: PPPD and AD showed divergent, exploratory VR-based response profiles: PPPD was marked by visual dependence, prolonged tolerance, and greater disorientation, while AD showed higher anxiety burden and earlier avoidance. These preliminary, hypothesis-generating findings suggest scenario-based VR assessment may merit further study as an adjunct in differentiating PPPD from anxiety disorder, pending diagnostic-accuracy validation in larger, multicenter cohorts.