仰卧位倾斜试验早期舒张压反应对良性阵发性位置性眩晕复发的影响。

Effect of the early diastolic blood pressure response to the head-up tilt test on the recurrence of benign paroxysmal positional vertigo.

机构信息

Department of Otorhinolaryngology, One Otorhinolaryngology Clinic, Paju, Republic of Korea.

Department of Laboratory Medicine, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Republic of Korea.

出版信息

PLoS One. 2024 May 2;19(5):e0301800. doi: 10.1371/journal.pone.0301800. eCollection 2024.

DOI:10.1371/journal.pone.0301800

PMID:38696405

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11065201/

Abstract

BACKGROUND

Otolith organ acts complementarily with the autonomic nervous system to maintain blood pressure. However, the effect of blood pressure variability in the autonomic nervous system on otolith organ has not yet been determined. This study aimed to verify the hypothesis that blood pressure variability in the autonomic nervous system affects the recurrence of benign paroxysmal positional vertigo (BPPV), which is the most common disease of the vestibular organs, by using the head-up tilt test (HUTT).

METHODS

This study included 432 patients diagnosed with idiopathic BPPV. The follow-up period for all patients was 12 months. Age, sex, hypertension, diabetes and recurrence were analyzed. The HUTT parameters were divided into a group of patients whose average diastolic blood pressure increased in the upright position compared to supine position during the HUTT (DBP1) and a group of patients whose average diastolic blood pressure decreased in the upright position compared to supine position during the HUTT (DBP2). Model selection, general loglinear analysis, and logit loglinear analysis were performed using a hierarchically progressing loglinear analysis.

RESULTS

In summary, the group with increased average diastolic blood pressure (DBP1) showed a higher tendency for BPPV recurrence compared to the group with decreased diastolic blood pressure (DBP2) in the upright position during the HUTT, although the difference was not statistically significant (p = 0.080). However, in males, the DBP1 group demonstrated a significantly higher recurrence rate of BPPV than the DBP2 group during the HUTT (95% CI, -20.021 to -16.200; p < 0.001).

CONCLUSIONS

It is presumed that poor autonomic nervous system response through vestibulosympathetic reflex maintains elevated diastolic blood pressure in the upright position during the HUTT. This variability is assumed to affect the recurrence of BPPV.

摘要

背景

耳石器官与自主神经系统协同作用以维持血压。然而，自主神经系统中血压变异性对耳石器官的影响尚未确定。本研究旨在通过直立倾斜试验（HUTT）验证以下假说，即自主神经系统中血压变异性通过前庭交感反射影响良性阵发性位置性眩晕（BPPV）的复发，BPPV 是前庭器官最常见的疾病。

方法

本研究纳入了 432 例特发性 BPPV 患者。所有患者的随访时间均为 12 个月。分析年龄、性别、高血压、糖尿病和复发情况。将 HUTT 参数分为直立位时平均舒张压较仰卧位升高（DBP1）组和直立位时平均舒张压较仰卧位降低（DBP2）组。采用层次逐步对数线性分析对模型选择、一般对数线性分析和对数线性分析进行分析。

结果

总之，与直立位时舒张压降低（DBP2）组相比，HUTT 中平均舒张压升高（DBP1）组的 BPPV 复发倾向更高，尽管差异无统计学意义（p = 0.080）。然而，在男性中，DBP1 组在 HUTT 中 BPPV 的复发率明显高于 DBP2 组（95%CI：-20.021 至-16.200；p<0.001）。