肥胖与良性阵发性位置性眩晕的关联机制综述OA

Benign paroxysmal positional vertigo(BPPV)is the most common peripheral vestibular disorder in clinical practice,with an estimated lifetime prevalence of approximately 2.4%.Although otoconial dislodgement is the fundamental pathological basis,increasing attention has been paid to the contribution of systemic factors-particularly metabolic and nutritional status-to disease onset,recurrence,and clinical outcomes.Against the backdrop of the global obesity epidemic,the association between obesity and BPPV has become a focus of investigation;however,current evidence does not support a consistent direct causal relationship.By synthesizing available epidemiological,pathophysiological,and clinical data,this review shows that most cross-sectional studies report an association between overweight/obesity and BPPV prevalence,yet the association often attenuates or disappears after multivariable adjustment,and Mendelian randomization analyses have not identified obesity as an independent risk factor.Mechanistically,obesity is more likely to influence BPPV through indirect pathways,including metabolic syndrome-related microvascular dysfunction,chronic low-grade inflammation and oxidative stress,disrupted vitamin D/calcium homeostasis,and sarcopenia,thereby destabilizing the inner-ear microenvironment and otoconia and ultimately increasing susceptibility to onset and recurrence while reducing therapeutic benefit.Clinically,in addition to standardized canalith repositioning procedures,a comprehensive strategy integrating"metabolic intervention plus vestibular protection"is warranted.This includes screening and control of metabolic comorbidities,optimized vitamin D/calcium supplementation,resistance training with preservation of muscle function,and long-term follow-up within a multidisciplinary care model.Future work should prioritize large prospective cohorts,refined body-composition phenotyping,and targeted interventional trials to clarify key links and optimize individualized management.