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[基于巴兰尼协会诊断标准对诊断为晕动病障碍患者的半规管和耳石重力感受通路功能评估]

[Evaluation of semicircular canal and otolith graviceptive pathway function in patients diagnosed with motion sickness disorder based on the diagnostic criteria of the Bárány society].

作者信息

Song N, Wu Y X, Zhao T T, Ma X Y, Wang Q Q, Yang X

机构信息

Department of Neurology, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing 100049, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2024 Apr 9;104(14):1149-1154. doi: 10.3760/cma.j.cn112137-20230927-00581.

Abstract

To investigate the altered function of the semicircular canal and otolith graviceptive pathway in patients diagnosed with motion sickness disorder (MSD) based on the diagnostic criteria of the Bárány society, and explore its relevance to the pathogenesis of MSD. This is a case-control study. Twenty patients with MSD and age-and sex-matched healthy controls without a history of MSD from the Department of Neurology of Aerospace Center Hospital between March and August 2022 were recruited. All subjects completed the motion sickness susceptibility questionnaire-short version (MSSQ-short) and the motion sickness assessment questionnaire (MSAQ). Canal function was evaluated using caloric stimulation test and video head impulse test (vHIT), and subjective visual vertical/horizontal (SVV/SVH) and vestibular evoked myogenic potential (VEMP) were employed to assess otolith graviceptive function. Differences in vestibular function and correlations between the two groups were analyzed. Each group consisted of 20 cases (9 males and 11 females). The mean age of the MSD and control groups was (26.9±3.9) years and (27.0±3.4) years, respectively. The scores of MSSQ-short [27.0 (22.5, 38.8) vs 1.2 (0, 3.2), <0.001] and MSAQ [70.1 (54.5, 78.1) vs 11.8 (11.1, 13.9), <0.001] were significantly higher in the MSD group compared with those of the control group. Evaluation of canal function revealed a significantly higher incidence of caloric stimulation intolerance in MSD patients (60.0%, 12/20) compared with that of the control group (20.0%, 4/20) (=0.010). Evaluation of otolith graviceptive pathway indicated no significant difference in SVV, SVH and cervical VEMP (cVEMP) abnormality rates between the two groups (all >0.05). The ocular VEMP (oVEMP) abnormality rate was significantly higher in the MSD group (55.0%, 11/20) than that of the control group (10.0%, 2/20) (=0.002), with a delayed P1-wave latency compared with the control group [(18.4±1.2) ms vs (17.6±0.8) ms, =0.018]. Further correlation analysis revealed that P1-wave latency in oVEMP was positively correlated with MSSQ-short (=0.486, =0.002) and MSAQ (=0.391, =0.015) scores, and duration of caloric intolerance symptoms (=0.377, =0.004). The presence of hypersensitivity to caloric stimulation and delayed latency of otolith function in patients with MSD suggests a "separation" between semicircular canal and otolithic function, which may be related to sensory conflict.

摘要

根据巴兰尼协会的诊断标准,研究被诊断为晕动病障碍(MSD)患者的半规管和耳石重力感受通路功能改变,并探讨其与MSD发病机制的相关性。这是一项病例对照研究。招募了2022年3月至8月期间来自航天中心医院神经内科的20例MSD患者以及年龄和性别匹配、无MSD病史的健康对照者。所有受试者均完成了晕动病易感性问卷简版(MSSQ-short)和晕动病评估问卷(MSAQ)。使用冷热试验和视频头脉冲试验(vHIT)评估半规管功能,采用主观视觉垂直/水平(SVV/SVH)和前庭诱发肌源性电位(VEMP)评估耳石重力感受功能。分析两组前庭功能差异及相关性。每组20例(男性9例,女性11例)。MSD组和对照组的平均年龄分别为(26.9±3.9)岁和(27.0±3.4)岁。MSD组的MSSQ-short评分[27.0(22.5,38.8)对1.2(0,3.2),<0.001]和MSAQ评分[70.1(54.5,78.1)对11.8(11.1,13.9),<0.001]显著高于对照组。半规管功能评估显示,MSD患者冷热刺激不耐受的发生率(60.%,12/20)显著高于对照组(20.0%,4/20)(P=0.010)。耳石重力感受通路评估表明,两组间SVV、SVH和颈肌前庭诱发肌源性电位(cVEMP)异常率无显著差异(均>0.05)。MSD组的眼肌前庭诱发肌源性电位(oVEMP)异常率(55.0%,11/20)显著高于对照组(10.0%,2/20)(P=0.002),且与对照组相比P1波潜伏期延迟[(18.4±1.2)ms对(17.6±0.8)ms,P=0.018]。进一步的相关性分析显示,oVEMP中的P1波潜伏期与MSSQ-short评分(r=0.486,P=0.002)、MSAQ评分(r=0.391,P=0.015)以及冷热不耐受症状持续时间(r=0.377,P=0.004)呈正相关。MSD患者存在对冷热刺激的超敏反应和耳石功能潜伏期延迟,提示半规管和耳石功能之间存在“分离”,这可能与感觉冲突有关。

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