前庭性偏头痛患者前庭功能的临床研究

发布时间：2018-06-25 01:09

本文选题：前庭性偏头痛 + 眩晕　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的：前庭性偏头痛（vestibular migrain，，VM）是引起反复发作性眩晕的常见疾病。2013年的国际头痛疾病分类中已明确了该疾病的诊断标准，但是该诊断标准的主要依据是患者疾病发作时的临床症状。在既往的研究中由于没有统一的诊断标准，因此缺乏关于VM患者全面的临床实验室检查的研究。本研究的目的是通过实验室检查来评估前庭性偏头痛患者的前庭功能，探寻其前庭功能特点。主要是通过冷热试验（caloric test）、摇头试验（head-shaking nystagmus，HNS）及速度阶梯实验来评估VM患者水平半规管的功能，颈肌性前庭诱发电位（cervical Vestibular Evoked Myogenic Potentials，cVEMP）来评估VM患者的耳石器（球囊）功能及球囊-颈反射通路状态，从而增加对前庭性偏头痛的病理生理学的理解。方法：对37例确诊为前庭性偏头痛的患者及30例健康志愿者分别行冷热试验、摇头试验、速度阶梯实验及颈肌性前庭诱发电位检查，对两组的冷热试验、摇头试验及速度阶梯试验中异常结果进行分析，对100dB的短音刺激情况下cVEMP不对称性进行分析。结果：前庭性偏头痛患者水平半规管功能的异常率要显著高于对照组，差异有统计学意义（P＜0.05）。37例VM患者中，有11例（29.7%）出现冷热试验异常，14例（37.8%）出现摇头试验异常，7例（18.9%）出现速度阶梯试验异常。30例健康志愿者中，有2例（6.7%）出现冷热试验异常，1例（3.3%）出现摇头试验异常，无患者出现速度阶梯试验异常。总体而言，28例（76％）VM患者至少在一个水平半规管功能试验中出现异常，异常率最高的是摇头试验，其次是冷热试验和速度阶梯试验。前庭性偏头痛患者的cVEMP异常率（21.6%）要显著高于对照组（3.3%），差异有统计学意义（P＜0.05）。结论：76％的前庭性偏头痛患者被发现存在前庭功能异常（即使在发作间期），在冷热试验的基础上加用摇头试验和旋转试验，可以提高VM患者前庭功能异常的检出率（即使在发作间期）。前庭性偏头痛患者显示的cVEMP结果，反映了球囊功能的异常及VM患者在球囊-颈反射通路上有所损害。前庭性偏头痛患者存在不同程度的前庭功能异常，需要进一步的研究。
[Abstract]:Objective: vestibular migraine (vestibular migraine VM) is a common disease that causes recurrent vertigo. The diagnostic criteria for this disease have been identified in the International Classification of headache Diseases in 2013, but the diagnostic criteria are mainly based on the clinical symptoms of the patients with the onset of the disease. In previous studies, due to lack of uniform diagnostic criteria, there is a lack of comprehensive clinical laboratory studies of VM patients. The purpose of this study was to evaluate vestibular function in patients with vestibular migraine by laboratory examination. The function of horizontal semicircular canal in VM patients was evaluated by head-shaking nystagmus test (head-shaking) and speed step test. Cervical vestibular evoked potential (cervical VEP) was used to evaluate the otostoneal (balloon) function and the state of balloon-neck reflex pathway in patients with VM, so as to enhance the understanding of pathophysiology of vestibular migraine. Methods: 37 patients with vestibular migraine and 30 healthy volunteers were tested with cold and heat test, shaking test, velocity step test and cervical vestibular evoked potential test. The abnormal results of shaking head test and velocity step test were analyzed, and the asymmetry of camp was analyzed under the condition of 100dB short tone stimulation. Results: the abnormal rate of semicircular canal function in patients with vestibular migraine was significantly higher than that in the control group (P < 0.05). There were 14 cases (37.8%) with abnormal cold and heat test and 7 cases (18.9%) with abnormal velocity step test in 11 cases (29.7%). Of the 30 healthy volunteers, 2 cases (6.7%) had abnormal cold and heat test and 1 case (3.3%) had abnormal shaking test. No patient had abnormal velocity step test. Overall, 28 (76%) patients with VM showed abnormalities in at least one horizontal semicircular canal function test. The highest abnormal rate was the shaking head test, followed by the cold and hot test and the velocity step test. The abnormal rate of camp in vestibular migraine patients (21.6%) was significantly higher than that in the control group (3.3%) (P < 0.05). Conclusion 76% of patients with vestibular migraine were found to have abnormal vestibular function (even during the interictal period). It can increase the detection rate of vestibular dysfunction in VM patients (even during interictal period). The results of camp in patients with vestibular migraine reflected abnormal balloon function and impairment of balloon-neck reflex pathway in VM patients. Vestibular migraine patients with varying degrees of vestibular dysfunction need further study.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R747.2

【参考文献】