【摘要】：目的:探索前庭誘發(fā)性肌源性電位(vestibular evoked myogenic potential,VEMP)及前庭冷熱試驗(caloric test)在梅尼埃病(Meniere disease,MD)不同聽力分期中的特征及臨床意義。材料與方法:對2015年7月至2016年5月期間就診于安徽省立醫(yī)院耳鼻咽喉科的梅尼埃病患者共60例,按梅尼埃病聽力分期標準分為1期9例,2期10例,3期26例,4期15例,行頸肌前庭誘發(fā)性肌源性電位(cervical vestibular evoked myogenic potential,c VEMP)、眼肌前庭誘發(fā)性肌源性電位(ocular vestibular evoked myogenic potential,o VEMP)及前庭冷熱試驗檢查,另納入正常參照組33人,建立VEMP實驗室正常范圍。結(jié)果:c VEMP在梅尼埃病患者1、2、3、4期中異常率分別為11.11%、40.00%、26.92%、33.33%,而o VEMP在各分期異常率分別為77.78%、70.00%、76.92%、80.00%,二者異常檢出率均呈總體上升趨勢,且在不同聽力分期組中及與正常參照組對比均有統(tǒng)計學意義(P0.05)。在可引出VEMP的梅尼埃病患者中,患側(cè)c VEMP在1,2,3,4不同聽力分期組振幅分別為78.05±28.99μV,87.60±25.98μV,76.54±28.56μV,62.59±31.62μV,o VEMP不同聽力分期組振幅分別為4.28±3.99μV,3.50±2.33μV,2.46±2.16μV,1.31±0.49μV,c VEMP及o VEMP振幅均呈總體下降趨勢。梅尼埃病患者前庭冷熱試驗異常檢出率隨梅尼埃病分期的增加上升顯著,在4期患者中高達86.67%。結(jié)論:梅尼埃病患者c VEMP、o VEMP及前庭冷熱試驗檢查異常檢出率均隨分期增加而呈總體上升趨勢,患側(cè)VEMP檢出電位振幅隨分期增加呈下降趨勢,提示梅尼埃病患者耳石器及水平半規(guī)管功能受損與病情程度正相關。在梅尼埃病患者VEMP檢查中,o VEMP對梅尼埃病各分期的檢出率均明顯高于c VEMP,對梅尼埃病患者的診斷更為高效。晚期梅尼埃病患者的前庭冷熱檢查異常檢出率明顯升高,而o VEMP更加適用于輕度聽力受損患者的診斷。c VEMP及o VEMP結(jié)合前庭冷熱試驗可共同評估梅尼埃病患者耳石器及水平半規(guī)管功能,并對進一步診療作出指導。
[Abstract]:Objective: to explore the characteristics and clinical significance of vestibular evoked myogenic potential (vestibular evoked myogenic potentialis-VEMP) and vestibular cold and hot test (caloric test) in different hearing stages of Meniere disease (MD). Materials and methods: from July 2015 to May 2016, 60 patients with Meniere's disease were admitted to the Department of Otorhinolaryngology, Anhui Provincial Hospital. According to the hearing staging criteria of Meniere's disease, they were divided into 9 cases of stage 1, 10 cases of stage 2 and 26 cases of stage 3 and 15 cases of stage 4. Cervical vestibular evoked myogenic potential (cervical vestibular evoked myogenic potentialc VEMP),) and vestibular evoked myogenic potential VEMP (ocular vestibular evoked myogenic potentialo VEMP) and vestibular cold and thermal tests were performed in 33 patients in the normal control group. The normal range of VEMP laboratory was established. Results in Meniere's disease patients, the abnormal rates of VEMP were 11.11 and 26.92%, respectively, while the abnormal rates of o VEMP in all stages were 77.78 and 76.92%, respectively. The detection rate of the two abnormalities showed an overall upward trend. And in different hearing stages group and normal reference group compared with statistical significance (P0.05). In Meniere's disease patients with VEMP, the amplitudes of c VEMP in different hearing staging groups were 78.05 鹵28.99 渭 V, 87.60 鹵25.98 渭 V, 76.54 鹵28.56 渭 V, 62.59 鹵31.62 渭 V, the amplitudes of c VEMP were 4.28 鹵3.99 渭 V, 3.50 鹵2.33 渭 V, 2.46 鹵2.16 渭 V, 1.31 鹵0.49 渭 V VEMP and o VEMP, respectively. The abnormal detection rate of vestibular cold and hot test in patients with Meniere's disease increased significantly with the increase of Meniere's disease stage, and reached 86.67 in stage 4 patients. Conclusion: the abnormal detection rate of c VEMPO VEMP and vestibular cold and thermal test in patients with Meniere's disease showed an overall upward trend with the increase of stage, and the amplitude of VEMP detection potential in the affected side showed a decreasing trend with the increase of stages. The results suggest that the impairment of otolithiasis and horizontal semicircular canal function in patients with Meniere's disease is positively correlated with the severity of the disease. In the VEMP examination of Meniere's disease, the detection rate of VEMP in all stages of Meniere's disease was significantly higher than that of c-VEMP.The diagnosis of Meniere's disease was more effective. The detection rate of abnormal vestibular cold and thermal examination in patients with advanced Meniere's disease was significantly higher than that in patients with advanced Meniere's disease. However, o VEMP is more suitable for the diagnosis of mild hearing impairment patients. C VEMP and o VEMP combined with vestibular cold and hot test can evaluate the otolithiasis and horizontal semicircular canal function in patients with Meniere's disease, and provide guidance for further diagnosis and treatment.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R764.33

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