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63例前庭神经炎患者临床特征的回顾性分析

[A retrospective analysis of the clinical characteristics of 63 patients with vestibular neuritis].

作者信息

Wang Qi, Yin Gendi, Zhang Shuqi, Huang Qiling, Li Lingwei, Li Zhicheng, Zeng Xiangli

机构信息

Department of Otolaryngology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou,510000,China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Jan;39(1):19-23. doi: 10.13201/j.issn.2096-7993.2025.01.005.

Abstract

To retrospectively analyze the results of auditory examination,vestibular function examination and laboratory examination of 63 patients diagnosed as vestibular neuritis.Methods:A total of 63 patients diagnosed with vestibular neuritis hospitalized in the Department of Otolaryngology, Head and Neck Surgery of the Third Affiliated Hospital of Sun Yat-sen University, from October 2012 to December 2022 were recruited. All patients met the diagnostic criteria for the 2022 Bárány association vestibular neuritis. Clinical data and the results of pure tone audiometry, electrocochleogram, video electronystagmogram, caloric test, cervical vestibuloevoked myogenic potential(cVEMP), ocular vestibuloevoked myogenic potential(oVEMP), video head impulse test(vHIT) was collected.A total of 63 age-and sex-matched healthy subjects in the physical examination center were randomly selected as the control group. The differences of blood indexs and lipid metabolism indexes between the two groups were compared. In patients with vestibular neuritis, 50 out of 63 patients presented normal threshold in pure tone audiometry, 8 out of 63 patients had bilateral high-frequency sensorineural hearing loss and 5 out of 63 patients had unilateral mild high-frequency sensorineural hearing loss, 56 out of 63 cases completed the electrocochleogram, of which 3 cases had a binaural-SP/AP amplitude ratio≥0.4, 5 cases had monaural amplitude ratio ≥0.4. Fifty-five out of 63 patients completed the caloric test with CP values greater than 30% in all. The ratio of patients completed cVEMP, oVEMP and vHIT were 46 cases, 22 cases and 30 cases, respectively. 17 out of 63 cases completed all the four vestibular function tests. According to these tests, 49 patients could determine the extent of injury,including 27 cases with unilateral superior vestibular nerve injury, 21 cases with unilateral superior and inferior vestibular nerve injury and 1 case with unilateral inferior vestibular nerve injury. There were significant differences in neutrophil value(<0.001), lymphocyte value(<0.005), neutrophil/lymphocyte ratio(<0.001) and apolipoprotein A1(<0.001) between patient group and control group. Inflammatory markers were risk factors for patients with vestibular neuritis. The OR values of neutrophil value and blood neutrophil/lymphocyte ratio were 1.81(1.38-2.37, <0.001) and 2.11(1.41-3.16, <0.001), respectively. Apolipoprotein A1 was a protective factor for patients with vestibular neuritis, and the value was 0.004(0.001-0.042, <0.001). Electrocochleogram could be used in vestibular neuritis patients with normal pure tone threshold to test whether there is hidden hearing loss in these patients. Neutrophil value, lymphocyte value, neutrophil/lymphocyte ratio and apolipoprotein A1 were correlated with vestibular neuritis. The Neutrophil value and neutrophil/lymphocyte ratio were risk factors for morbidity.

摘要

回顾性分析63例诊断为前庭神经炎患者的听力学检查、前庭功能检查及实验室检查结果。方法:选取2012年10月至2022年12月在中山大学附属第三医院耳鼻咽喉头颈外科住院的63例诊断为前庭神经炎的患者。所有患者均符合2022年巴拉尼协会前庭神经炎的诊断标准。收集临床资料及纯音听力计、耳蜗电图、视频眼震电图、冷热试验、颈前庭诱发肌源性电位(cVEMP)、眼前庭诱发肌源性电位(oVEMP)、视频头脉冲试验(vHIT)结果。随机选取体检中心63例年龄及性别匹配的健康受试者作为对照组。比较两组间血液指标及脂质代谢指标的差异。在前庭神经炎患者中,63例患者中有50例纯音听力计阈值正常,63例患者中有8例双侧高频感音神经性听力损失,63例患者中有5例单侧轻度高频感音神经性听力损失,63例中有56例完成了耳蜗电图检查,其中3例双耳SP/AP波幅比≥0.4,5例单耳波幅比≥0.4。63例患者中有55例完成了冷热试验,所有患者CP值均大于30%。完成cVEMP、oVEMP及vHIT检查的患者比例分别为46例、22例及30例。63例中有17例完成了全部四项前庭功能检查。根据这些检查,49例患者可确定损伤程度,其中单侧上前庭神经损伤27例,单侧上、下前庭神经损伤21例,单侧下前庭神经损伤1例。患者组与对照组中性粒细胞值(<0.001)、淋巴细胞值(<0.005)、中性粒细胞/淋巴细胞比值(<0.001)及载脂蛋白A1(<0.001)差异有统计学意义。炎症标志物是前庭神经炎患者的危险因素。中性粒细胞值及血液中性粒细胞/淋巴细胞比值的OR值分别为1.81(1.38 - 2.37,<0.001)及2.11(1.41 - 3.16,<0.001)。载脂蛋白A1是前庭神经炎患者的保护因素,其值为0.004(0.001 - 0.042,<0.001)。耳蜗电图可用于纯音阈值正常的前庭神经炎患者,检测这些患者是否存在隐匿性听力损失。中性粒细胞值、淋巴细胞值、中性粒细胞/淋巴细胞比值及载脂蛋白A1与前庭神经炎相关。中性粒细胞值及中性粒细胞/淋巴细胞比值是发病的危险因素。

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