外周前庭疾病中多维视频头脉冲试验参数的特异性疾病模式

文献信息

中文摘要

视频头脉冲试验（vHIT）的多维参数——即前庭眼反射（VOR）增益、增益不对称性（GA）和代偿性扫视（CS）——是评估外周前庭功能障碍的核心指标。vHIT与冷热试验的联合应用有助于各种眩晕综合征的鉴别诊断。在这项回顾性研究中，共纳入310例单侧外周前庭疾病成年患者，包括170例梅尼埃病（MD）、110例伴眩晕的突发性感音神经性听力损失（SSHL-V）和30例前庭神经炎（VN）。所有参与者均在症状发作72小时内、任何治疗干预之前接受了vHIT和冷热试验。对vHIT指标的分析揭示了三种疾病各具特点的损伤模式。梅尼埃病主要表现为水平半规管（SCC）的CS异常，增益下降率较低。伴眩晕的突发性感音神经性听力损失呈现累及水平和后半规管的多平面损伤。前庭神经炎则表现为水平半规管VOR增益和代偿性扫视的并发异常。在VOR增益正常的患者中，大多数半规管的CS阳性组单侧减弱（UW）值显著升高。按年龄分层分析显示，年龄对VOR增益或CS没有明显混杂效应。本研究系统描述了三种常见外周前庭疾病各具特点的vHIT参数特征，探讨了代偿性扫视与早期高频前庭功能障碍之间可能的关系，并考察了其与冷热试验结果的关系。

英文摘要

Video Head Impulse Test (vHIT) multidimensional parameters-namely vestibulo‑ocular reflex (VOR) gain, gain asymmetry (GA), and compensatory saccades (CS)-are core indicators for assessing peripheral vestibular dysfunction. The combined use of vHIT and caloric testing facilitates differential diagnosis of various vertigo syndromes. In this retrospective study, 310 adult patients with unilateral peripheral vestibular disorders were enrolled, comprising 170 cases of Ménière's disease (MD), 110 cases of sudden sensorineural hearing loss accompanied by vertigo (SSHL‑V), and 30 cases of vestibular neuritis (VN). All participants underwent vHIT and a caloric test within 72 hours of symptom onset, prior to any therapeutic intervention. Analysis of vHIT metrics revealed distinct impairment patterns across the three disorders. Ménière's disease was primarily characterized by CS abnormalities in the lateral semicircular canal (SCC), with a low gain reduction rate. Sudden sensorineural hearing loss with vertigo presents multi-planar impairment affecting both the lateral and posterior SCCs. Vestibular neuritis displayed concurrent abnormalities in VOR gain and compensatory saccades in the lateral SCC. In patients with normal VOR gain, unilateral weakness (UW) values were significantly elevated in CS‑positive groups for most semicircular canals. Age-stratified analysis revealed that age did not exert a discernible confounding effect on VOR gain or CS. This study systematically delineates the distinct vHIT parameter profiles of three common peripheral vestibular disorders, explores the possible relationship between compensatory saccades and early high-frequency vestibular dysfunction, and examines their relationship with caloric test outcomes.