前庭神经炎患者半规管高频功能恢复状况与临床疗效的多因素回归分析OA
Multifactorial regression analysis of semicircular canal high-frequency function recovery and clinical efficacy in patients with vestibular neuritis
目的 探究视频头脉冲试验(video-head impulse test,vHIT)对前庭神经炎(vestibular neuritis,VN)患者半规管高频功能恢复程度的预测价值.方法 回顾性纳入2019年9月至2024年3月北京市海淀医院耳鼻喉科收治的147例VN患者为研究对象,根据半规管高频功能恢复程度将患者分为恢复良好组81例和恢复不良组66例.比较两组临床资料及vHIT试验指标.采用受试者工作特征(receiver operating characteristics,ROC)曲线评估各指标对半规管高频功能恢复程度的预测价值.采用多因素Logistic回归分析半规管高频功能恢复的独立影响因素.利用ROC曲线评估Logistic回归模型的区分度,通过构建校准曲线评估模型预测准确性,利用决策曲线分析衡量模型的临床实用性,采用强化Bootstrap方法对模型进行内部验证,评估模型内部验证过程中的整体表现.结果 恢复不良组颈椎病、偏头痛、脑卒中及睡眠障碍例数均高于恢复良好组,差异有统计学意义(P<0.05);恢复不良组前庭眼反射(vestibular-ocularreflex,VOR)增益值低于恢复良好组,VOR增益值不对称比阳性率、扫视波例数、vHIT异常例数高于恢复良好组,差异均有统计学意义(P<0.05).vHIT各指标对预测治疗半规管高频功能恢复具有一定指导价值(P<0.05),其中VOR增益值准确性较高(P<0.05),各指标联合判断恢复不良准确性最高(P<0.05).多因素Logistic回归结果显示,偏头痛、脑卒中、VOR增益值、VOR增益不对称比是预测半规管高频功能恢复的独立预测因素.结论 偏头痛、脑卒中、VOR增益值及VOR增益不对称比是预测半规管高频功能恢复的独立因素,基于这些指标构建的联合模型可有效预测恢复情况,为临床干预提供重要参考.
Objective To report on the predictive value of the video head impulse test(vHIT)for the recovery of semicircular canal high-frequency function in patients with vestibular neuritis(VN).Methods A total of 147 VN patients admitted to the Department of Otolaryngology at Haidian Hospital in Beijing from September 2019 to March 2024 were divided into a good-recovery(81 cases)and a poor recovery group(66 cases)base on the level of semicircular canal high-frequency function recovery.Their clinical data and vHIT test indicators were compared.The receiver operating characteristic(ROC)curve was used to determine the predictive value of each indicator for semicircular canal high-frequency function recovery.Multivariate logistic regression analysis was employed to identify independent factors affecting semicircular canal high-frequency function recovery.The differentiating ability of the logistic regression model was assessed using ROC curves,the predictive accuracy was evaluated by constructing a calibration curve,and decision curve analysis was used to measure the clinical utility of the model.Internal validation of the model was conducted using the enhanced Bootstrap method to comprehensively evaluate the overall performance of the model.Results The number of cases with cervical spondylosis,migraine,stroke and sleep disorders in the poor recovery group was higher than in the good recovery group(P<0.05),while the vestibular-ocular reflex(VOR)gain values in the poor recovery group were lower than those in the good recovery group.The number of patients with saccadic waves and the rate of abnormal vHIT in cases with positive gain asymmetry were higher in the poor recovery group than in the good recovery group(P<0.05).Various vHIT indicators showed certain guiding values in predicting the recovery of semicircular canal high-frequency function after treatment(P<0.05),with the VOR gain value demonstrating relatively high accuracy(P<0.05),and the combination of all indicators showing the highest accuracy in identifying poor recovery(P<0.05).Multivariate logistic regression results showed that migraine,stroke,VOR gain value and VOR gain asymmetry ratio were independent predictors of semicircular canal high-frequency function recovery.Conclusions Migraine,stroke,VOR gain values and VOR gain asymmetry ratio are independent factors predicting semicircular canal high-frequency function recovery.A combined model based on these indicators can effectively predict recovery and provide important references for clinical interventions.
严森;李征玥;陈平;吴文
北京市海淀医院耳鼻喉科,北京 100080北京市海淀医院耳鼻喉科,北京 100080北京市海淀医院耳鼻喉科,北京 100080北京市海淀医院耳鼻喉科,北京 100080
前庭神经炎视频头脉冲试验半规管高频功能
vestibular neuritisvideo-head impulse testsemicircular canal high-frequency function
《中华耳科学杂志》 2026 (4)
289-296,8
北京市海淀医院2020年院级科研基金项目(KYQ2020028)
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