冷热试验半规管麻痹阈值与vHIT定义的急性单侧前庭功能障碍的关系：一项回顾性分析

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中文摘要

背景： 冷热试验和前庭视频头脉冲试验（vHIT）评估不同频率范围的前庭功能，在急性眩晕患者中提供互补信息。尽管通常使用25%的半规管麻痹（CP）阈值来定义冷热试验异常，但结合vHIT定义的单侧高频前庭功能障碍来解读CP值在临床上仍具有挑战性。
目的： 我们评估了传统和替代性冷热试验CP阈值与vHIT定义的急性单侧前庭功能障碍的一致性，并寻求一个与vHIT定义结果最对应的解读性CP阈值。
方法： 这项回顾性分析纳入了在症状发作72小时内出现急性眩晕的患者，这些患者在一家三级转诊中心接受了冷热试验和vHIT。排除了临床怀疑良性阵发性位置性眩晕、梅尼埃病、前庭性偏头痛、突发性感音神经性听力损失或伴有急性听觉症状的迷路炎、中枢性前庭疾病、双侧前庭病或双侧冷热试验减弱的患者。vHIT定义的单侧功能障碍基于相容的临床特征和异常的水平半规管vHIT结果，表明单侧高频前庭眼反射功能障碍。受试者工作特征（ROC）分析检查了冷热试验CP值与此分类的对应关系。
结果： 在1,634名符合条件的患者中，145名符合vHIT定义的单侧功能障碍标准。有症状的vHIT正常对照组包括1,489名没有最终诊断为明确外周或中枢前庭疾病的患者，尽管其中一些有孤立的冷热试验异常。传统的25% CP阈值对基于vHIT的分类显示出高敏感性，但将更多有症状的vHIT正常患者分类为CP异常。ROC分析确定了一个约30%的CP阈值（约登指数），敏感性为0.945，特异性为0.867。与25%相比，该阈值减少了vHIT不一致的冷热试验异常分类，同时与vHIT定义的分类保持密切对应。
结论： 在急性眩晕发作72小时内评估的患者中，约30%的CP阈值与vHIT定义的单侧高频前庭功能障碍显示出最密切的对应关系。它应被解释为结合vHIT结果解读冷热试验CP的实用基准，而不是AUVP的独立诊断标准。

英文摘要

BACKGROUND: Caloric testing and the video head impulse test (vHIT) assess vestibular function at different frequency ranges and provide complementary information in patients with acute vertigo. Although a canal paresis (CP) threshold of 25% is commonly used to define caloric abnormality, interpreting CP values in relation to vHIT-defined unilateral high-frequency vestibular dysfunction remains clinically challenging.
OBJECTIVE: We evaluated how conventional and alternative caloric CP thresholds align with vHIT-defined acute unilateral vestibular dysfunction and sought an interpretive CP threshold best corresponding to vHIT-defined findings.
METHODS: This retrospective analysis included patients presenting with acute vertigo within 72 h of symptom onset who underwent both caloric testing and vHIT at a tertiary referral center. Patients with clinically suspected benign paroxysmal positional vertigo, Ménière's disease, vestibular migraine, sudden sensorineural hearing loss or labyrinthitis with acute auditory symptoms, central vestibular disorders, bilateral vestibulopathy, or bilateral caloric weakness were excluded. vHIT-defined unilateral dysfunction was based on compatible clinical features and abnormal horizontal-canal vHIT findings indicating unilateral high-frequency vestibulo-ocular reflex dysfunction. Receiver operating characteristic (ROC) analysis examined how caloric CP values corresponded to this classification.
RESULTS: Of 1,634 eligible patients, 145 met criteria for vHIT-defined unilateral dysfunction. The symptomatic vHIT-normal comparison group comprised 1,489 patients without a final diagnosis of definite peripheral or central vestibular disease, although some had isolated caloric abnormalities. The conventional 25% CP threshold showed high sensitivity for the vHIT-based classification but classified a larger number of symptomatic vHIT-normal patients as CP abnormal. ROC analysis identified an approximately 30% CP threshold (Youden's index) with sensitivity 0.945 and specificity 0.867. This threshold reduced vHIT-discordant caloric abnormal classifications compared with 25% while maintaining close correspondence with the vHIT-defined classification.
CONCLUSION: In patients evaluated within 72 h of acute vertigo onset, a CP threshold of approximately 30% showed the closest correspondence with vHIT-defined unilateral high-frequency vestibular dysfunction. It should be interpreted as a practical benchmark for interpreting caloric CP in relation to vHIT findings, not as an independent diagnostic criterion for AUVP.