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目的:通过前庭自旋转试验(VAT)分析前庭性偏头痛(VM)患者的前庭眼反射特征,探讨VAT技术在前庭性偏头痛辅助诊断中的临床应用价值。方法:分别对临床确诊的VM患者69例、后循环缺血(PCI)性眩晕患者73例、正常人65例在完成临床检查的基础上行VAT测试,以VAT增益、相位及非对称性为指标,分析比较其前庭眼反射特征。结果:(1)69例VM患者中水平或垂直增益异常为54例(78.3%);水平或/和垂直相位延迟66例(95.7%);非对称性异常13例(异常率为18.8%)。(2)54例增益异常的VM患者中,46例(66.7%)为高增益,42例表现为高增益伴高相位,36例表现为单纯水平高增益(且主要集中在2~4 Hz异常,26例);8例(11.6%)表现为低增益。(3)PCI组VAT特征:73例PCI患者中,47例(64.4%)为高增益,11例(15.1%)表现为低增益,主要呈高增益。PCI组与VM组比较,高增益、低增益差异均无统计学意义(χ~2=0.07、0.37,P>0.05)。VM组与PCI组的VAT均以高增益为主,差异无统计学意义;在相位延迟及非对称指标中差异有统计学意义。(4)正常人组VAT特征:四项指标异常阳性率较低。正常人组与VM组比较,高增益及相位延迟差异均有统计学意义(χ~2=56.17、97.57,P<0.01),低增益非及对称性比较差异无统计学意义。结论:VM的前庭眼反射以高增益为主,多呈现在2~4Hz频率段,且多伴有相位延迟。VM主要累及前庭中枢,VAT检测可为VM诊断提供参考。
Objective: To investigate the clinical value of VAT in the diagnosis of vestibular migraine by analyzing the vestibular reflex characteristics of vestibular migraine (VM) patients by vestibular rotation test (VAT). Methods: Sixty-nine patients with clinically diagnosed VM, 73 patients with posterior circulation ischemia (PCI) vertigo, and 65 normal subjects underwent VAT testing on the basis of the completed clinical examination. The indicators of VAT gain, phase and asymmetry , Analysis and comparison of the characteristics of the vestibular reflex. Results: (1) The abnormalities of horizontal or vertical gain in 69 patients with VM were 54 (78.3%), 66 patients (95.7%) delayed in horizontal and / or vertical phase, 13 patients had abnormal asymmetry (18.8% . (2) Of the 54 patients with abnormally high frequency of VM, 46 (66.7%) were high-gain, 42 were high-gain with high phase and 36 were high-gain at simple level , 26 cases); 8 cases (11.6%) showed low gain. (3) VAT characteristics of PCI group: Of the 73 patients with PCI, 47 (64.4%) had high gain and 11 (15.1%) showed low gain with high gain. PCI group and VM group, high gain, low gain difference was not statistically significant (χ ~ 2 = 0.07,0.37, P> 0.05). The VAT of VM group and PCI group were mainly high-gain, with no significant difference. There was significant difference between phase delay and asymmetry index. (4) normal group VAT features: four indicators of abnormal positive rate is low. Compared with VM group, the difference of high gain and phase delay in normal group was statistically significant (χ ~ 2 = 56.17, 97.57, P <0.01). There was no significant difference in low gain and non-symmetry. CONCLUSIONS: The vestibular reflex in VM is dominated by high gain, mostly in the frequency range of 2 ~ 4 Hz, and is accompanied by phase delay. VM mainly affects the vestibular center, VAT detection can provide a reference for VM diagnosis.