本文選題：前庭性偏頭痛 + 眩暈　； 參考：《安徽醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：前庭性偏頭痛（vestibular migrain，，VM）是引起反復(fù)發(fā)作性眩暈的常見(jiàn)疾病。2013年的國(guó)際頭痛疾病分類中已明確了該疾病的診斷標(biāo)準(zhǔn)，但是該診斷標(biāo)準(zhǔn)的主要依據(jù)是患者疾病發(fā)作時(shí)的臨床癥狀。在既往的研究中由于沒(méi)有統(tǒng)一的診斷標(biāo)準(zhǔn)，因此缺乏關(guān)于VM患者全面的臨床實(shí)驗(yàn)室檢查的研究。本研究的目的是通過(guò)實(shí)驗(yàn)室檢查來(lái)評(píng)估前庭性偏頭痛患者的前庭功能，探尋其前庭功能特點(diǎn)。主要是通過(guò)冷熱試驗(yàn)（caloric test）、搖頭試驗(yàn)（head-shaking nystagmus，HNS）及速度階梯實(shí)驗(yàn)來(lái)評(píng)估VM患者水平半規(guī)管的功能，頸肌性前庭誘發(fā)電位（cervical Vestibular Evoked Myogenic Potentials，cVEMP）來(lái)評(píng)估VM患者的耳石器（球囊）功能及球囊-頸反射通路狀態(tài)，從而增加對(duì)前庭性偏頭痛的病理生理學(xué)的理解。方法：對(duì)37例確診為前庭性偏頭痛的患者及30例健康志愿者分別行冷熱試驗(yàn)、搖頭試驗(yàn)、速度階梯實(shí)驗(yàn)及頸肌性前庭誘發(fā)電位檢查，對(duì)兩組的冷熱試驗(yàn)、搖頭試驗(yàn)及速度階梯試驗(yàn)中異常結(jié)果進(jìn)行分析，對(duì)100dB的短音刺激情況下cVEMP不對(duì)稱性進(jìn)行分析。結(jié)果：前庭性偏頭痛患者水平半規(guī)管功能的異常率要顯著高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。37例VM患者中，有11例（29.7%）出現(xiàn)冷熱試驗(yàn)異常，14例（37.8%）出現(xiàn)搖頭試驗(yàn)異常，7例（18.9%）出現(xiàn)速度階梯試驗(yàn)異常。30例健康志愿者中，有2例（6.7%）出現(xiàn)冷熱試驗(yàn)異常，1例（3.3%）出現(xiàn)搖頭試驗(yàn)異常，無(wú)患者出現(xiàn)速度階梯試驗(yàn)異常�？傮w而言，28例（76％）VM患者至少在一個(gè)水平半規(guī)管功能試驗(yàn)中出現(xiàn)異常，異常率最高的是搖頭試驗(yàn)，其次是冷熱試驗(yàn)和速度階梯試驗(yàn)。前庭性偏頭痛患者的cVEMP異常率（21.6%）要顯著高于對(duì)照組（3.3%），差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。結(jié)論：76％的前庭性偏頭痛患者被發(fā)現(xiàn)存在前庭功能異常（即使在發(fā)作間期），在冷熱試驗(yàn)的基礎(chǔ)上加用搖頭試驗(yàn)和旋轉(zhuǎn)試驗(yàn)，可以提高VM患者前庭功能異常的檢出率（即使在發(fā)作間期）。前庭性偏頭痛患者顯示的cVEMP結(jié)果，反映了球囊功能的異常及VM患者在球囊-頸反射通路上有所損害。前庭性偏頭痛患者存在不同程度的前庭功能異常，需要進(jìn)一步的研究。
[Abstract]:Objective: vestibular migraine (vestibular migraine VM) is a common disease that causes recurrent vertigo. The diagnostic criteria for this disease have been identified in the International Classification of headache Diseases in 2013, but the diagnostic criteria are mainly based on the clinical symptoms of the patients with the onset of the disease. In previous studies, due to lack of uniform diagnostic criteria, there is a lack of comprehensive clinical laboratory studies of VM patients. The purpose of this study was to evaluate vestibular function in patients with vestibular migraine by laboratory examination. The function of horizontal semicircular canal in VM patients was evaluated by head-shaking nystagmus test (head-shaking) and speed step test. Cervical vestibular evoked potential (cervical VEP) was used to evaluate the otostoneal (balloon) function and the state of balloon-neck reflex pathway in patients with VM, so as to enhance the understanding of pathophysiology of vestibular migraine. Methods: 37 patients with vestibular migraine and 30 healthy volunteers were tested with cold and heat test, shaking test, velocity step test and cervical vestibular evoked potential test. The abnormal results of shaking head test and velocity step test were analyzed, and the asymmetry of camp was analyzed under the condition of 100dB short tone stimulation. Results: the abnormal rate of semicircular canal function in patients with vestibular migraine was significantly higher than that in the control group (P < 0.05). There were 14 cases (37.8%) with abnormal cold and heat test and 7 cases (18.9%) with abnormal velocity step test in 11 cases (29.7%). Of the 30 healthy volunteers, 2 cases (6.7%) had abnormal cold and heat test and 1 case (3.3%) had abnormal shaking test. No patient had abnormal velocity step test. Overall, 28 (76%) patients with VM showed abnormalities in at least one horizontal semicircular canal function test. The highest abnormal rate was the shaking head test, followed by the cold and hot test and the velocity step test. The abnormal rate of camp in vestibular migraine patients (21.6%) was significantly higher than that in the control group (3.3%) (P < 0.05). Conclusion 76% of patients with vestibular migraine were found to have abnormal vestibular function (even during the interictal period). It can increase the detection rate of vestibular dysfunction in VM patients (even during interictal period). The results of camp in patients with vestibular migraine reflected abnormal balloon function and impairment of balloon-neck reflex pathway in VM patients. Vestibular migraine patients with varying degrees of vestibular dysfunction need further study.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R747.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 郭艷娥;于生元;吳子明;;偏頭痛患者前庭誘發(fā)肌源性電位的臨床應(yīng)用[J];中國(guó)現(xiàn)代神經(jīng)疾病雜志;2010年06期

2 周娜,吳子明,張素珍,郭維維,于黎明,楊偉炎,韓東一;不同刺激模式前庭誘發(fā)肌源性電位的反應(yīng)特性[J];中華耳鼻咽喉科雜志;2004年08期

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