伴发梅尼埃病的良性阵发性位置性眩晕的临床特点

doi:10.6040/j.issn.1673-3770.1.2019.024

摘要/Abstract

摘要： 目的

探讨伴发梅尼埃病患者的良性阵发性位置性眩晕（BPPV）的临床特点及治疗结果。

方法

256例BPPV患者纳入研究，排除32例继发性BPPV。28例并发梅尼埃病的BPPV患者为试验组，196例不伴梅尼埃病的特发性BPPV为对照组，均经位置试验诊断，并采用管石复位法治疗，比较两组患者的年龄、性别、病变侧别、BPPV类型、病程等临床特点及治疗结果。

结果

与对照组比较，试验组中女性更常见（P<0.05），外侧半规管受累更多见（P<0.001）。两组平均年龄及受累侧别无统计学差异。75%的BPPV发生侧与梅尼埃病受累侧相同且都发生在MD诊断之后。试验组在治疗后的1 d、1周及1个月的治愈率都差于对照组(P<0.01, P<0.05, P<0.05)。

结论

并发梅尼埃病的BPPV患者与特发性BPPV的临床特点有显著不同，试验组患者的女性更常见，外半规管更易受累，BPPV患者都发生于MD诊断之后，此类患者有不同的临床过程且对管石复位治疗反应差。

关键词: 梅尼埃病, 良性阵发性位置性眩晕, 管石复位法, 位置试验, 治疗结局

Abstract: Objective

To study the clinical characteristics and treatment outcomes of patients with benign paroxysmal positional vertigo (BPPV) associated with Meniere′s disease (MD).

Method

A total of 256 patients with BPPV were enrolled in the study, of which 32 patients with secondary BPPV were excluded. Out of the remaining 224 patients, 28 patients having BPPV associated with MD were included in the trial group and 196 patients with no adjunctive problem associated with BPPV (idiopathic) were included in the control group. All the patients were diagnosed using the Dix-Hallpike positional test and were treated with canalith repositioning procedure (CRP). The age, sex, site of involvement, type of BPPV, duration of symptoms, and treatment outcomes were compared.

Results

The clinical manifestations of BPPV were seen more commonly among the females in the trial group. (P<0.05). Involvement of the lateral canal of the ear was more common in patients in the trial group (P<0.001). There was no statistical difference in the average age and in right and left ear involvement between groups. BPPV was ipsilateral to the ear with MD in 75% of patients and MD was present before the diagnosis of BPPV in all patients. Comparative analyses of the cure rate of both groups after 1 day, 1 week, and 1 month were significant (P<0.01, P<0.05, P<0.05 respectively).

Conclusion

The clinical features and therapeutic outcomes of MD-associated BPPV differ from those of idiopathic BPPV. MD-associated BPPV was found to be more frequent in females and the lateral canal involvement was higher in most patients. Patients were already affected by MD before the development of BPPV. This disease may follow a different clinical course and respond less effectively to CRP treatment.

Key words: Meniere′s disease, Benign paroxysmal positional vertigo, Canalith repositioning procedure, Positional test, Treatment outcome

中图分类号:

R764

王登元,陈智斌,王杪琳. 伴发梅尼埃病的良性阵发性位置性眩晕的临床特点[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 61-65.

Dengyuan WANG,Zhibin CHEN,Miaolin WANG. An assessment of the clinical features of benign paroxysmal positional vertigo associated with Meniere' s disease[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 61-65.

图/表 1

表1

伴有MD的BPPV患者与特发性BPPV的临床特点比较分析"

指标	试验组（n=28）	对照组（n=196）	χ^２/ t	P
性别			4.644	0.031
男	5	76
女	23	120
年龄（ $x ˉ ± s$ ，岁）	45.3±7.9 （30~60）	42.1±8.5 （26~76）	1.968	0.057
BPPV病程（ $x ˉ ± s,$ d）	53.2±11.7	41.2±10.8	5.45	0.000
BPPV侧别			0.127	0.721
左侧	13	84
右侧	15	112
受累半规管
后半规管	13	127	3.527	0.060
外半规管	15	27	25.469	0.000
上半规管		13
多半规管		29

表1

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