AlGarni Mohammed A, Mirza Ahmad A, Althobaiti Awwadh A, Al-Nemari Hanan H, Bakhsh Lamees S
Department of Surgery-Otolaryngology Section, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
Eur Arch Otorhinolaryngol. 2018 Nov;275(11):2705-2711. doi: 10.1007/s00405-018-5146-6. Epub 2018 Oct 9.
Benign paroxysmal positional vertigo (BPPV) is an idiopathic recurrent inner ear illness that is caused most often by an imbalance in the metabolism of calcium carbonate crystals (otoconia) inside the semicircular canals, in which the otoconia begin to circulate freely after being dislodged from the basic structure. The underlying etiology of this imbalance has not yet been well established; however, a few recent articles have revealed that vitamin D level abnormality in these patients might play a role. Therefore, we conducted the current systematic review analysis to explore potential associations of vitamin D level with the occurrence as well as the recurrence of BPPV disease.
A comprehensive literature search was conducted using different databases to retrieve all of the articles that have evaluated possible associations, irrespective of the study design. Then, we reported different vitamin D3 levels from BPPV groups and control groups to estimate the standardized mean difference (SMD) between the BPPV and control groups. We also calculated the effect size of each study under the random effects statistical model.
Of the 703 studies that we identified, only 37 studies were found to be potential for our analysis, and of these, only seven met our predetermined criteria. Two meta-analyses were conducted with respect to the occurrence and the recurrence of BPPV. When the BPPV cases were compared to the controls (free of BPPV disease), there was an insignificant reduction in vitamin D level among the diseased groups (SMD = - 2.20; 95% CI - 6.66 to 2.26). In contrast, when the recurrent BPPV groups were compared with the non-recurrent BPPV groups, the statistical analysis showed significantly lower level of vitamin D among the recurrence BPPV groups (SMD = - 4.47; 95% CI - 7.55 to - 1.29).
Although a negative vitamin D imbalance has been reported among some BPPV patients, this review analysis failed to establish a relationship between the occurrence of BPPV and low vitamin D level. However, low vitamin D level was significantly evident among patients with recurrent episodes of BPPV.
良性阵发性位置性眩晕（BPPV）是一种特发性复发性内耳疾病，最常见的病因是半规管内碳酸钙结晶（耳石）代谢失衡，耳石从基本结构上脱落之后开始自由循环。这种失衡的潜在病因尚未完全明确；然而，最近的一些文章显示，这些患者的维生素D水平异常可能起了一定作用。因此，我们进行了本次系统综述分析，以探讨维生素D水平与BPPV疾病的发生及复发之间的潜在关联。
使用不同数据库进行全面的文献检索，以检索所有评估了可能关联的文章，无论研究设计如何。然后，我们报告了BPPV组和对照组不同的维生素D3水平，以估计BPPV组与对照组之间的标准化均数差（SMD）。我们还在随机效应统计模型下计算了每项研究的效应量。
在我们识别出的703项研究中，仅有37项研究有潜力纳入我们的分析，其中只有7项符合我们预定的标准。针对BPPV的发生和复发进行了两项荟萃分析。将BPPV病例与对照组（无BPPV疾病）进行比较时，患病组的维生素D水平有不显著的降低（SMD = -2.20；95%CI -6.66至2.26）。相反，将复发性BPPV组与非复发性BPPV组进行比较时，统计分析显示复发性BPPV组的维生素D水平显著较低（SMD = -4.47；95%CI -7.55至-1.29）。
尽管在一些BPPV患者中报告了维生素D呈负性失衡，但本次综述分析未能证实BPPV的发生与低维生素D水平之间存在关联。然而，在复发性BPPV患者中，低维生素D水平明显显著。
