梅尼埃病与前庭性偏头痛的鉴别：症状与诊断见解的综合综述。

文献信息

中文摘要

背景： 梅尼埃病和前庭性偏头痛是常见的发作性前庭综合征，其重叠的眩晕、听觉和偏头痛相关特征可使鉴别诊断复杂化。方法：在这篇叙述性综述中，我们比较了这些综合征的诊断标准、症状模式、病理生理学以及辅助检查发现。结果：前庭性偏头痛基于复发性前庭症状、偏头痛病史、与偏头痛特征的时间关联以及排除其他原因进行临床诊断；听力学和前庭评估并非必需。相比之下，若患者表现为发作性眩晕，并有听力学记录的低至中频感音神经性听力损失和波动性耳部症状，则可诊断为确定的梅尼埃病。因此，系列听力学检查在梅尼埃病的诊断中发挥直接作用，而冷热试验、视频头脉冲试验、前庭诱发肌源性电位和内淋巴积水成像提供的是支持性而非独立的鉴别证据。新兴研究已发现梅尼埃病与前庭性偏头痛之间存在不同的细胞因子和免疫特征。在一个研究队列中，白细胞介素-1β、CC基序趋化因子配体3、CC基序趋化因子配体22和CXC基序趋化因子配体1组成的细胞因子组合已显示出高鉴别性能（曲线下面积=0.995），而多组学研究已识别出不同的免疫细胞通路。然而，在这些方法可用于常规诊断之前，需要外部验证和标准化的临床阈值。结论：在实践中，鉴别应基于纵向病史和共识标准，并在临床有指征时辅以系列听力评估和针对性的前庭或影像学检查。

英文摘要

Meniere's disease and vestibular migraine are common episodic vestibular syndromes whose overlapping vertigo, auditory, and migraine-associated features can complicate differential diagnosis. In this narrative review, we compared the diagnostic criteria, symptom patterns, pathophysiology, and complementary test findings of these syndromes. Vestibular migraine is diagnosed clinically based on recurrent vestibular symptoms, migraine history, temporal association with migraine features, and exclusion of alternative causes; audiological and vestibular evaluations are not required. In contrast, diagnosis of definite Meniere's disease is made if the patient exhibits episodic vertigo with audiometrically documented low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms. Therefore, serial audiometry plays a direct role in the diagnosis of Meniere's disease, whereas caloric testing, video head impulse testing, vestibular-evoked myogenic potentials, and hydrops imaging provide supportive rather than standalone discriminatory evidence. Emerging studies have identified distinct cytokine and immune signatures between Meniere's disease and vestibular migraine. In one research cohort, an interleukin-1 beta, CC motif chemokine ligand 3, CC motif chemokine ligand 22, and CXC motif chemokine ligand 1 cytokine panel has demonstrated high discriminatory performance (area under the curve = 0.995), whereas multiomic studies have identified divergent immune-cell pathways. However, external validation and standardized clinical thresholds are required before these approaches can be adopted for routine diagnosis. In practice, differentiation should be anchored in longitudinal history and consensus criteria, supplemented by serial hearing assessment and targeted vestibular or imaging studies when clinically indicated.