临床实践中的头晕：来自多学科患者队列的见解

文献信息

中文摘要

背景与目的： 本研究旨在描述在三级多学科门诊因头晕评估而被转诊的患者的临床表现、共病特征和诊断结局。
对象与方法： 我们开展了一项纳入254例患者的回顾性观察性研究。数据提取自结构化接诊表格，包括人口学资料、症状类型和频率、共病、头晕残障量表（DHI）评分、既往医疗服务利用情况以及最终诊断。统计分析包括描述性统计、方差分析、卡方检验和Spearman相关性分析，以探讨DHI评分与临床变量之间的关系。
结果： 大多数患者报告每日症状和多种加重因素，包括头部运动和应激。焦虑（44.5%）和记忆主诉（47.2%）是常见共病。平均DHI评分为34.2（标准差=16.8），反映轻至中度的感知残障。外周前庭疾病是最常见的诊断类别（42.9%），其次是非外周性病因（37.8%）。不同诊断类别之间的DHI评分存在显著差异（p<0.001），在PPPD、合并前庭疾病和非外周性诊断组中观察到更高的评分。然而，DHI评分与症状频率、共病或医疗服务利用史无显著关联。
结论： 头晕的表现具有异质性，常涉及诊断延迟延长、症状重叠和心理社会共病。本研究结果支持需要更早获得前庭评估和整合的多学科管理，以减少慢性头晕患者的残障并改善结局。

英文摘要

BACKGROUND AND OBJECTIVES: This study aimed to characterize the clinical presentation, comorbidity profiles, and diagnostic outcomes of patients referred for dizziness assessment at a tertiary-level multidisciplinary clinic.
SUBJECTS AND METHODS: We conducted a retrospective observational study involving 254 patients. Data were extracted from structured intake forms and included demographics, symptom type and frequency, comorbidities, Dizziness Handicap Inventory (DHI) scores, prior healthcare utilization, and final diagnoses. Statistical analyses included descriptive statistics, analysis of variance, chi-square tests, and Spearman's correlations to explore the relationships between DHI scores and clinical variables.
RESULTS: Most patients reported daily symptoms and multiple aggravating factors, including head movements and stress. Anxiety (44.5%) and memory complaints (47.2%) were common comorbidities. The mean DHI score was 34.2 (standard deviation=16.8), reflecting a mild-to-moderate perceived handicap. Peripheral vestibular disorders were the most common diagnostic category (42.9%), followed by non-peripheral causes (37.8%). Significant differences in DHI scores were observed across diagnostic categories (p<0.001), with higher scores observed in PPPD, combined vestibular disorders, and non-peripheral diagnostic groups. However, DHI scores were not significantly associated with symptom frequency, comorbidities, or healthcare utilization history.
CONCLUSIONS: Dizziness presentation is heterogeneous and frequently involves prolonged diagnostic delays, overlapping symptomatology, and psychosocial comorbidities. This study's findings support the need for earlier access to vestibular assessments and integrated multidisciplinary management to reduce disability and improve outcomes for patients with chronic dizziness.