摘要
目的 通过分析梅尼埃病患者气导短纯音诱发的颈肌前庭肌源性诱发电位（cervical vestibular-evoked myogenic potential，cVEMP）和眼肌前庭诱发肌源性电位（ocular vestibular-evoked myogenic potential，oVEMP）的引出特点，探讨前庭耳石器通路功能与梅尼埃病临床分期之间的关系及其应用价值。
方法 收集56例（56耳）单侧梅尼埃病患者作为研究对象，选择性别和年龄与之匹配的50名（100耳）健康人作为对照组，所有受试者均进行双耳cVEMP和oVEMP检测。根据梅尼埃病患耳cVEMP和oVEMP检查结果的异常情况对其前庭囊斑功能进行分级（cVEMP和oVEMP均正常者为前庭囊斑功能1级，其中一项检查结果异常者为前庭囊斑功能2级，两项检查结果均异常者为前庭囊斑功能3级）。观察梅尼埃病患耳临床分期与VEMP检测结果以及前庭囊斑功能分级之间的联系。结果 梅尼埃病患耳cVEMP的异常率为57.1%（32/56），oVEMP的异常率为64.3%（36/56），与健康对照组组比较，差异均具有统计学意义（χ2＝22.286，P＝0.000；χ2＝15.217，P＝0.000）。一～四期梅尼埃病患耳cVEMP和oVEMP的异常率分别为：一期，20.0%（1/5）和40.0%（2/5）；二期，50.0%（9/18）和50.0%（9/18）；三期，59.3%（16/27）和70.4%（19/27）；四期，100.0%（6/6）和100.0%（6/6）；不同分期之间cVEMP异常率比较，差异具有统计学意义（Fisher确切概率法，P＝0.046），不同分期之间oVEMP异常率的比较，差异无统计学意义（Fisher确切概率法，P＝0.077）。梅尼埃病患者前庭囊斑功能分级与临床分期之间呈正相关（rs＝＝0.417，P＝0.001）。结论 梅尼埃病患者存在球囊（前庭下神经通路）和椭圆囊（前庭上神经通路）客观前庭机能检查的异常；随着病程进展，cVEMP和oVEMP的异常率有逐渐增加的趋势；根据cVEMP和oVEMP检测结果可以评估梅尼埃病患者前庭受累的程度和范围，并为临床分期提供参考。
Objective To observe the features of air-conducted sound elicited ocular vestibular-evoked myogenic potential（ACS-oVEMP） and cervical vestibular-evoked myogenic potential（ACS-cVEMP） in patients with Meniere disease （MD）. To analyze the relationship between air-conducted sound elicited vestibular-evoked myogenic potentials （ACS-VEMP） responses and clinical stages of disease, as well as its clinical application of cervical and ocular vestibular evoked myogenic potentials in MD.Method Fifty six patients with MD and 50 normal subjects （100 ears） were recruited for conventional cVEMP and oVEMP examinations. Grades of vestibular function were also collected for patients with MD. The relationship between VEMPs abnormity, grades of vestibular function and clinical stages of MD were analyzed.Results The abnormal rates of cVEMP and oVEMP in MD patients were 57.1% （32/56） and 64.3% （36/56）, which were significantly higher than those in normal subjects respectively （χ2=22.286, P=0.000; χ2=15.217, P=0.000）. The abnormal rates of cVEMP and oVEMP in MD patients of stage Ⅰ to stage Ⅳ were 20.0% （1/5） and 40.0% （2/5）, 50.0% （9/18） and 50.0% （9/18）, 59.3% （16/27） and 70.4% （19/27）, and 100.0% （6/6） and 100.0% （6/6） respectively. There was a significant difference in cVEMP abnormity between four stages of MD patients （P=0.046）. Significant correlation was found between clinical stages and the grades of vestibular dysfunction （rs=0.417, P=0.001）.Conclusions Dysfunction of vestibular otolithic organs and their input pathways in patients with MD can be detected by cVEMP and oVEMP tests. The abnormal rates of VEMP could show an gradually increasing trend with the development of MD stages. And the extent of vestibular lesions could be detected by cVEMP and oVEMP tests, which may provide a reference for clinical staging of MD.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2017年第3期195-199,共5页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
国家自然科学基金（81670945、81504140）
中央高校基本科研业务费专项资金（2012jdhz13）
陕西省国际科技合作重点项目（2017KW）
西安市科技攻关项目[SF1315（1）]
西安交通大学医学院第二附属医院人才培养专项基金[RC（GG）201407]
关键词
梅尼埃病
前庭诱发肌源性电位
球囊和椭圆囊
Meniere disease
Vestibular evoked myogenic potentials
Saccule and utricle
作者简介
通信作者：张青，Email：zhqent@163．com
