前庭诱发肌源性电位、冷热试验和耳蜗电图在梅尼埃病诊断中的评估价值
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摘要
目的:评估前庭诱发肌源性电位(cVEMP和oVEMP)、冷热试验和耳蜗电图(ECochG)在梅尼埃病(MD)和非MD患者中的诊断价值。方法:将64例(64耳)单侧MD患者作为研究对象(MD组),另收集同期其他眩晕症非MD门诊患者127例(254耳)作为非MD组,其中前庭性偏头痛40例、良性阵发性位置性眩晕48例、良性复发性眩晕13例、前庭阵发症3例、前庭神经炎5例以及其他不明原因的眩晕患者18例。对2组患者双耳进行cVEMP、oVEMP、冷热试验和ECochG检测。将所有ECochG数据录入Medcalc软件,绘制ECochGSP/AP值在MD组与非MD组的ROC曲线,计算曲线下面积、约登指数以及最佳诊断截点等。将ECochGSP/AP最佳截点定为耳蜗积水的截点,评估3项前庭功能检查异常与ECochG-SP/AP阳性在MD组和非MD组中诊断MD的灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)和诊断准确度。结果:计算得ECochG的ROC曲线下面积为0.74,约登指数为0.47,最佳诊断截点为-SP/AP>0.40。在MD组与非MD组的眩晕患者中,单项前庭功能检查,包括cVEMP(灵敏度约为62%,特异度约为68%)、oVEMP(灵敏度约为61%,特异度约为53%)和冷热试验(灵敏度约为53%,特异度约为57%)的灵敏度和特异度都低于ECochG(灵敏度约为65%、特异度约为78%);而PPV以ECochG最高,为61.9%;NPV在cVEMP、oVEMP和ECochG都较高,最高为cVEMP(87.5%);诊断准确度以ECochG最高(约为74%),其次为cVEMP(约为67%),而oVEMP(约为55%)和冷热试验(约为56%)较低。结论:ECochG与单项前庭功能检查相比,灵敏度、特异度、诊断准确度和NPV方面均较高,并且-SP/AP值>0.4时可将诊断效益提高到最大。因此,单个前庭功能检查(包括cVEMP、oVEMP和冷热试验)在MD诊断中价值有限,MD的诊断仍然需要从病史、听力学检查(包括纯音测听、ECochG等)和前庭功能检查来进行综合评估。
Objective:The aim of this study is to evaluate the diagnostic value of vestibular-evoked myogenic potential(cVEMP and oVEMP),caloric test,and cochlear electrogram(EcochG)in patients with Meniere's disease(MD)and non-Meniere's disease.Method:Sixty-four patients(64 ears)with Unilateral Meniere's disease were enrolled in the study group(MD group),and 127 cases(254 ears)of non-Meniere's disease patients as nonMD group,including vertigo migraine in 40 cases,benign paroxysmal positional vertigo in 48 cases,benign recurrent vertigo in 13 cases,vestibular paroxysmia in 3 cases,vestibular neuritis in 5 cases and other undiagnosed vertigo in 18 cases.Both group undertake cVEMP,oVEMP,caloric test and ECochG.Use Medcale software to draw ROC curve of ECochG and calculate the area under curve(AUC),Jordan index and optimal diagnostic cut-off points.Make the cut-off point as the point of-SP/AP,then evaluate the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and diagnostic accuracy of cVEMP,oVEMP,caloric test and ECochG in MD group and non-MD group.Result:The AUC of ECochG ROC curve was 0.74,the Jordan index was 0.47 and the cut-off point was 0.4.The sensitivity and specificity of cVEMP(62%and 68%),oVEMP(61%and 53%)and caloric test(53% and 57%)were all below ECochG(65% and 78%).The positive predictive value and of ECochG was the highest(61.9%),the negative predictive value of cVEMP was highest(87.5%).The diagnostic accuracy of ECochG was highest(74%),followed with cVEMP(67%),oVEMP(55%)and caloric test(56%).Conclusion:Compared with the vestibular function tests,the sensitivity,specificity,diagnostic accuracy and NPV were all higher in ECochG,and the diagnostic benefit can be maximized when-SP/AP value>0.4.So the value of single vestibular function examination in the diagnosis of Meniere's disease is limited.The diagnosis of MD still requires a comprehensive evaluation in combination with medical history,audiological tests and vestibular function examinations.
Objective:The aim of this study is to evaluate the diagnostic value of vestibular-evoked myogenic potential(cVEMP and oVEMP),caloric test,and cochlear electrogram(EcochG)in patients with Meniere's disease(MD)and non-Meniere's disease.Method:Sixty-four patients(64 ears)with Unilateral Meniere's disease were enrolled in the study group(MD group),and 127 cases(254 ears)of non-Meniere's disease patients as nonMD group,including vertigo migraine in 40 cases,benign paroxysmal positional vertigo in 48 cases,benign recurrent vertigo in 13 cases,vestibular paroxysmia in 3 cases,vestibular neuritis in 5 cases and other undiagnosed vertigo in 18 cases.Both group undertake cVEMP,oVEMP,caloric test and ECochG.Use Medcale software to draw ROC curve of ECochG and calculate the area under curve(AUC),Jordan index and optimal diagnostic cut-off points.Make the cut-off point as the point of-SP/AP,then evaluate the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and diagnostic accuracy of cVEMP,oVEMP,caloric test and ECochG in MD group and non-MD group.Result:The AUC of ECochG ROC curve was 0.74,the Jordan index was 0.47 and the cut-off point was 0.4.The sensitivity and specificity of cVEMP(62%and 68%),oVEMP(61%and 53%)and caloric test(53% and 57%)were all below ECochG(65% and 78%).The positive predictive value and of ECochG was the highest(61.9%),the negative predictive value of cVEMP was highest(87.5%).The diagnostic accuracy of ECochG was highest(74%),followed with cVEMP(67%),oVEMP(55%)and caloric test(56%).Conclusion:Compared with the vestibular function tests,the sensitivity,specificity,diagnostic accuracy and NPV were all higher in ECochG,and the diagnostic benefit can be maximized when-SP/AP value>0.4.So the value of single vestibular function examination in the diagnosis of Meniere's disease is limited.The diagnosis of MD still requires a comprehensive evaluation in combination with medical history,audiological tests and vestibular function examinations.
引文
[1]VAN TILBURG M J,HERRMANN B S,GUINAN JJ Jr,et al.Serial cVEMP Testing is Sensitive to Disease Progression in Ménière Patients[J].Otol Neurotol,2016,37:1614-1619.
[2]JOHNSON S A,O'BEIRNE G A,LIN E,et al.oVEMPs and cVEMPs in patients with'clinically certain'Menière's disease[J].Acta Otolaryngol,2016,136:1029-1034.
[3]CHEN L,XU H,WANG W Q,et al.Evaluation of the otolith function using c/oVEMPs in patients with Ménière's disease[J].J Otolaryngol Head Neck Surg,2016,45:39-39.
[4]YOUNG Y H,HUANG T W,CHENG P W.Assessing the stage of Meniere's disease using vestibular evoked myogenic potentials[J].Arch Otolaryngol Head Neck Surg,2003,129:815-818.
[5]MARGOLIS R H,RIEKS D,FOURNIER E M,et al.Tympanic electrocochleography for diagnosis of Menière's disease[J].Arch Otolaryngol Head Neck Surg,1995,121:44-55.
[6]NGUYEN L T,HARRIS J P,NGUYEN Q T.Clinical utility of electrocochleography in the diagnosis and management of Ménière's disease:AOS and ANSmembership survey data[J].Otol Neurotol,2010,31:455-459.
[7]VON BREVERN M,LEMPERT T.Vestibular migraine[J].Handb Clin Neurol,2016,137:301-316.
[8]STRUPP M,LOPEZ-ESCAMEZ J A,KIM J S,et al.Vestibular paroxysmia:Diagnostic criteria[J].J Vestib Res,2016,26:409-415.
[9]李兴启,郑杰夫,郗昕.听觉诱发反应及应用[M].北京:人民军医出版社,2007:140-153.
[10]张青,宋辉,胡娟,等.气导短纯音诱发的眼肌前庭诱发肌源性电位在健康青年人群中的波形特征[J].中华耳鼻咽喉头颈外科杂志,2012,47(1):15-18.
[11]SHEYKHOLESLAMI K,MUROFUSHI T,KAGAK.The effect of sternocleidomastoid electrode location on vestibular evoked myogenic potential[J].Auris Nasus Larynx,2001,28:41-43.
[12]李晓璐,卜行宽,BARIN K,等.实用眼震电图和眼震视图检查[M].北京:人民卫生出版社,2015:128-133.
[13]KATAYAMA N,YAMAMOTO M,TERANISHIM,et al.Relationship between endolymphatic hydrops and vestibular-evokedmyogenic potential[J].Acta Otolaryngol,2010,130:917-923.
[14]TAYLOR R L,WIJEWARDENE A A,GIBSON W P.The vestibular evoked-potential profile of Ménière's disease[J].Clin Neurophysiol,2011,122:1256-1263.
[15]MUROFUSHI T,NAKAHARA H,YOSHIMURAE,et al.Association of air-conducted sound oVEMPfindings with cVEMP and caloric test findings in patients with unilateral peripheral vestibular disorders[J].Acta Otolaryngol,2011,131:945-950.
[16]LAMOUNIER P,DE SOUZA T S A,GOBBO D A,et al.Evaluation of vestibular evoked myogenic potentials(VEMP)and electrocochleography for the diagnosis of Ménière's disease[J].Braz J Otorhinolaryngol,2017,83:394-403.
[17]EGAMI N,USHIO M,YAMASOBA T,et al.The diagnostic value of vestibular evoked myogenic potentials in patients with Meniere's disease[J].J Vestib Res,2013,23:249-257.
[18]OH S Y,KIM J S,YANG T H,et al.Cervical and ocular vestibular-evoked myogenic potentials in vestibular neuritis:comparison between air-and bone-conducted stimulation[J].J Neurol,2013,260:2102-2109.
[19]BAIER B,STIEBER N,DIETERICH M.Vestibular-evoked myogenic potentials in vestibular migraine[J].JNeurol,2009,256:1447-1454.
[20]NAKAHARA H,YOSHIMURA E,TSUDA Y,et al.Damaged utricular function clarified by oVEMP in patients with benign paroxysmal positional vertigo[J].Acta Otolaryngol,2013,133:144-149.
[2]JOHNSON S A,O'BEIRNE G A,LIN E,et al.oVEMPs and cVEMPs in patients with'clinically certain'Menière's disease[J].Acta Otolaryngol,2016,136:1029-1034.
[3]CHEN L,XU H,WANG W Q,et al.Evaluation of the otolith function using c/oVEMPs in patients with Ménière's disease[J].J Otolaryngol Head Neck Surg,2016,45:39-39.
[4]YOUNG Y H,HUANG T W,CHENG P W.Assessing the stage of Meniere's disease using vestibular evoked myogenic potentials[J].Arch Otolaryngol Head Neck Surg,2003,129:815-818.
[5]MARGOLIS R H,RIEKS D,FOURNIER E M,et al.Tympanic electrocochleography for diagnosis of Menière's disease[J].Arch Otolaryngol Head Neck Surg,1995,121:44-55.
[6]NGUYEN L T,HARRIS J P,NGUYEN Q T.Clinical utility of electrocochleography in the diagnosis and management of Ménière's disease:AOS and ANSmembership survey data[J].Otol Neurotol,2010,31:455-459.
[7]VON BREVERN M,LEMPERT T.Vestibular migraine[J].Handb Clin Neurol,2016,137:301-316.
[8]STRUPP M,LOPEZ-ESCAMEZ J A,KIM J S,et al.Vestibular paroxysmia:Diagnostic criteria[J].J Vestib Res,2016,26:409-415.
[9]李兴启,郑杰夫,郗昕.听觉诱发反应及应用[M].北京:人民军医出版社,2007:140-153.
[10]张青,宋辉,胡娟,等.气导短纯音诱发的眼肌前庭诱发肌源性电位在健康青年人群中的波形特征[J].中华耳鼻咽喉头颈外科杂志,2012,47(1):15-18.
[11]SHEYKHOLESLAMI K,MUROFUSHI T,KAGAK.The effect of sternocleidomastoid electrode location on vestibular evoked myogenic potential[J].Auris Nasus Larynx,2001,28:41-43.
[12]李晓璐,卜行宽,BARIN K,等.实用眼震电图和眼震视图检查[M].北京:人民卫生出版社,2015:128-133.
[13]KATAYAMA N,YAMAMOTO M,TERANISHIM,et al.Relationship between endolymphatic hydrops and vestibular-evokedmyogenic potential[J].Acta Otolaryngol,2010,130:917-923.
[14]TAYLOR R L,WIJEWARDENE A A,GIBSON W P.The vestibular evoked-potential profile of Ménière's disease[J].Clin Neurophysiol,2011,122:1256-1263.
[15]MUROFUSHI T,NAKAHARA H,YOSHIMURAE,et al.Association of air-conducted sound oVEMPfindings with cVEMP and caloric test findings in patients with unilateral peripheral vestibular disorders[J].Acta Otolaryngol,2011,131:945-950.
[16]LAMOUNIER P,DE SOUZA T S A,GOBBO D A,et al.Evaluation of vestibular evoked myogenic potentials(VEMP)and electrocochleography for the diagnosis of Ménière's disease[J].Braz J Otorhinolaryngol,2017,83:394-403.
[17]EGAMI N,USHIO M,YAMASOBA T,et al.The diagnostic value of vestibular evoked myogenic potentials in patients with Meniere's disease[J].J Vestib Res,2013,23:249-257.
[18]OH S Y,KIM J S,YANG T H,et al.Cervical and ocular vestibular-evoked myogenic potentials in vestibular neuritis:comparison between air-and bone-conducted stimulation[J].J Neurol,2013,260:2102-2109.
[19]BAIER B,STIEBER N,DIETERICH M.Vestibular-evoked myogenic potentials in vestibular migraine[J].JNeurol,2009,256:1447-1454.
[20]NAKAHARA H,YOSHIMURA E,TSUDA Y,et al.Damaged utricular function clarified by oVEMP in patients with benign paroxysmal positional vertigo[J].Acta Otolaryngol,2013,133:144-149.
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