慢性头晕：神经敏化与心理敏化。

文献信息

中文摘要

本综述旨在探讨驱动从急性前庭事件向慢性头晕转变的潜在机制，重点关注神经敏化和心理敏化在症状持续中的作用。从前庭代偿、感觉重加权和恐惧-回避模型的角度分析前庭性头晕的演变。急性前庭损伤后，中枢神经系统功能可通过前庭代偿、感觉重加权和突触可塑性部分恢复。然而，这一恢复过程常伴随视觉依赖性增加，为神经敏化的发生提供了基础。恐惧-回避模型所描述的本体感觉与视觉输入的异常整合不仅促进中枢敏化，还揭示了心理敏化的核心特征：由灾难化认知和回避行为驱动的知觉放大。慢性头晕患者对视觉和本体感觉刺激表现出超敏反应，感觉处理阈值降低，这反映了神经敏化层面的异常感觉增益。心理因素则通过调节本体感觉处理和边缘系统活动来维持或加剧神经敏化。神经敏化和心理敏化相互强化，构成从急性前庭事件向慢性头晕转变的关键环节。针对感觉重加权、恐惧-回避行为和精神共病的综合干预可能有助于中断这一过程。

英文摘要

This review aims to investigate the potential mechanisms driving the transition from acute vestibular events to chronic dizziness, focusing on the roles of neural sensitization and psychological sensitization in symptom persistence. The evolution of vestibular dizziness is analyzed from the perspectives of vestibular compensation, sensory reweighting, and the fear-avoidance model. After acute vestibular injury, central nervous system function can be partially restored through vestibular compensation, sensory reweighting, and synaptic plasticity. However, this recovery process is often accompanied by increased visual dependence, which provides a foundation for the development of neural sensitization. The abnormal integration of proprioceptive and visual input described by the fear-avoidance model not only contributes to central sensitization but also reveals the core feature of psychological sensitization: perceptual amplification driven by catastrophizing cognition and avoidance behavior. Patients with chronic dizziness exhibit hypersensitivity to visual and proprioceptive stimuli and reduced sensory processing thresholds, which reflects abnormal sensory gain at the level of neural sensitization. Psychological factors, in turn, maintain or exacerbate neural sensitization by modulating proprioceptive processing and limbic system activity. Neural sensitization and psychological sensitization mutually reinforce each other, constituting a critical link in the transition from acute vestibular events to chronic dizziness. Comprehensive interventions targeting sensory reweighting, fear-avoidance behavior, and psychiatric comorbidity may help interrupt this process.