视频头脉冲试验在良性阵发性位置性眩晕诊断中的应用：文献系统综述

文献信息

中文摘要

背景： 良性阵发性位置性眩晕（BPPV）是最常见的外周前庭疾病，通常依据特征性位置性眼震进行诊断。尽管视频头脉冲试验（vHIT）在前庭疾病中的应用日益增多，但其在BPPV中的作用仍不明确，尤其是在较少见的变异型中。本系统综述和荟萃分析旨在探讨BPPV中由vHIT测得的前庭眼反射（VOR）增益，并描述较少见变异型中的vHIT表现。方法：通过系统文献检索，识别报告BPPV患者vHIT表现的研究。对于定量合成，纳入至少包含35例常见BPPV变异型患者的研究，并使用随机效应荟萃分析对后半规管（PSC）VOR增益进行分析。较少见的变异型单独考虑，不设最小样本量标准，并进行定性合成，包括病例报告、病例系列以及回顾性和前瞻性研究。结果：十项研究符合定量合成的纳入标准，而一项关于典型BPPV的研究进行了定性分析，六项研究探讨了较少见的BPPV变异型；这六项研究中的一项也为定量合成提供了数据。在典型PSC-BPPV中，vHIT通常显示前庭眼反射功能保留，VOR增益处于或接近正常范围。汇总分析显示PSC VOR增益无临床相关降低。在较少见的变异型中，vHIT表现异质性较大，尽管大多数患者显示管特异性VOR功能保留。结论：vHIT在典型BPPV诊断中的作用似乎有限。然而，在较少见的变异型中，前庭反应可能不典型，vHIT可能提供额外的诊断信息。需要更大规模且更同质人群的进一步研究，以阐明vHIT表现在不常见BPPV变异型中的诊断和病理生理意义。

英文摘要

Background: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and is typically diagnosed based on characteristic positional nystagmus. Although video head impulse testing (vHIT) is increasingly used in vestibular disorders, its role in BPPV remains unclear, particularly in less common variants. This systematic review and meta-analysis aimed to investigate vestibulo-ocular reflex (VOR) gain measured by vHIT in BPPV and to describe vHIT findings in less common variants. Methods: A systematic literature search identified studies reporting vHIT findings in patients with BPPV. For the quantitative synthesis, studies including at least 35 patients with common BPPV variants were eligible, and posterior semicircular canal (PSC) VOR gain was analysed using a random-effects meta-analysis. Less common variants were considered separately without a minimum sample-size criterion and qualitatively synthesised, including case reports, case series, and retrospective and prospective studies. Results: Ten studies met the inclusion criteria for the quantitative synthesis, while one study about typical BPPV underwent qualitative analysis and six studies investigated less common BPPV variants; one of these six studies also contributed to the quantitative synthesis. In typical PSC-BPPV, vHIT generally showed preserved vestibulo-ocular reflex function, with VOR gain within or close to the normal range. The pooled analysis showed no clinically relevant reduction in PSC VOR gain. In less common variants, vHIT findings were heterogeneous, although most patients showed preserved canal-specific VOR function. Conclusions: vHIT appears to have a limited role in the diagnosis of typical BPPV. However, it may provide additional diagnostic information in less common variants, where vestibular responses can be atypical. Further studies with larger and more homogeneous populations are needed to clarify the diagnostic and pathophysiological significance of vHIT findings in uncommon BPPV variants.