良性发作性位置性眩晕患者手法复位后复发的影响因素分析

刘斌; 许笑天; 符雪涛; 王英歌; 刘雨霏; 唐铁钰

doi:10.16766/j.cnki.issn.1674-4152.003449

良性发作性位置性眩晕患者手法复位后复发的影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003449

1.
扬州大学附属医院神经内科，江苏扬州 225001
2.
扬州大学附属医院康复医学科

基金项目:

国家自然科学基金项目 81901084

详细信息

通讯作者:
唐铁钰，E-mail：ydfytty@163.com

中图分类号: R764.3 R441.2
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- 文章访问数: 184
- HTML全文浏览量: 111
- PDF下载量: 14
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-19
- 网络出版日期: 2024-05-29

Analysis of factors affecting recurrence in patients with benign paroxysmal positional vertigo after manual repositioning

1.
Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225001, China

摘要

摘要: 目的通过分析良性发作性位置性眩晕(BPPV)患者手法复位后相关影响因素，探讨可能导致BPPV复发的潜在危险因素，为降低再发率提供理论基础。方法选取2020年1月—2021年12月于扬州大学附属医院神经内科门诊确诊BPPV并治愈的170例患者。随访2年，根据是否复发分为复发组(70例)和未复发组(100例)。统计患者资料并通过logistic回归分析研究复发的危险因素。结果 70例复发患者中，复发1次39例，复发2次27例，复发3次及以上的患者4例。Logistic回归分析显示女性(OR=11.623, 95% CI: 4.104~20.634, P < 0.001)、焦虑(OR=4.200, 95% CI: 1.186~14.873, P=0.026)、疲劳(OR=5.025, 95% CI: 1.771~14.255, P=0.002)、睡眠障碍(OR=4.080, 95% CI: 1.152~14.447, P=0.002)、外伤(OR=4.802, 95% CI: 1.692~13.622, P=0.023)以及合并高血压(OR=4.938, 95% CI: 1.740~14.009, P < 0.001)均是BPPV患者复发的危险因素，糖尿病、家族史和吸烟史与是否复发之间无明显相关性。结论性别、焦虑、疲劳、睡眠障碍、外伤以及合并高血压是BPPV患者复发的影响因素，可以更有针对性地对BPPV复发的管理和预防提供参考。
- 良性发作性位置性眩晕 /
- 手法复位 /
- 复发 /
- 影响因素
Abstract: Objective This study aims to analyze the factors influencing the recurrence of benign paroxysmal positional vertigo (BPPV) following manual repositioning, revealing potential risk factors for BPPV recurrence, and providing a theoretical basis for reducing the recurrence rate. Methods A total of 170 patients diagnosed with and cured for BPPV at the Neurology Department of Affiliated Hospital of Yangzhou University between January 2020 and December 2021 were selected in this study. A 2-year follow-up was conducted, and the patients were divided into the recurrence group (n=70) and non-recurrence group (n=100) based on recurrence status. Patient data were collected and logistic regression analysis was performed to identify risk factors associated with BPPV recurrence. Results Among the 70 recurrent patients, 39 experienced a single recurrence, while 27 encountered two recurrences, and 4 had three or more recurrences. Logistic regression analysis showed that female (OR=11.623, 95% CI: 4.104-20.634, P < 0.001), anxiety (OR=4.200, 95% CI: 1.186-14.873, P=0.026), fatigue (OR=5.025, 95% CI: 1.771-14.255, P=0.002), sleep disorder (OR=4.080, 95% CI: 1.152-14.447, P=0.002), trauma (OR=4.802, 95% CI: 1.692-13.622, P=0.023) and comorbid hypertension (OR=4.938, 95% CI: 1.740-14.009, P < 0.001) were risk factors for recurrence in BPPV patients, and diabetes, family history and smoking history were not significantly correlated with the presence or absence of recurrence. Conclusion Gender, anxiety, fatigue, sleep disorders, trauma, and hypertension were the influencing factors contributing to the recurrence of BPPV. These findings offer more targeted insights for the management and prevention of BPPV recurrence.
- Benign paroxysmal positional vertigo /
- Manual reduction /
- Recurrence /
- Influencing factors

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表 1 2组BPPV患者人口学及临床资料比较

Table 1. Comparison of demographic and clinical data of BPPV patients in 2 two groups

组别	例数	年龄 (x±s，岁)	性别[例(%)]		高血压 [例(%)]	睡眠障碍 [例(%)]	疲劳 [例(%)]	糖尿病 [例(%)]	家族史 [例(%)]	吸烟史 [例(%)]	外伤史 [例(%)]	焦虑 [例(%)]
组别	例数	年龄 (x±s，岁)	女性	男性	高血压 [例(%)]	睡眠障碍 [例(%)]	疲劳 [例(%)]	糖尿病 [例(%)]	家族史 [例(%)]	吸烟史 [例(%)]	外伤史 [例(%)]	焦虑 [例(%)]
复发组	70	49.63±8.94	61(87.14)	9(12.86)	45(64.29)	43(61.43)	25(35.71)	21(30.00)	26(37.14)	23(32.86)	17(24.29)	18(25.71)
未复发组	100	48.55±9.56	51(51.00)	49(49.00)	24(24.00)	34(34.00)	16(16.00)	16(16.00)	19(19.00)	13(13.00)	4(4.00)	10(10.00)
统计量		0.752^a	23.930^b		27.713^b	12.502^b	8.745^b	4.740^b	6.963^b	9.727^b	15.650^b	7.391^b
P值		0.458	<0.001		<0.001	<0.001	0.003	0.030	0.008	0.002	<0.001	0.007
注：^a为t值，^b为χ²值。

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表 2 变量赋值情况

Table 2. Variable assignment

变量	赋值方法
复发	否=0，是=1
性别	男性=0，女性=1
焦虑	无=0，有=1
糖尿病	无=0，有=1
家族史	无=0，有=1
吸烟史	无=0，有=1
疲劳	无=0，有=1
睡眠障碍	否=0，是=1
外伤	否=0，是=1
高血压	否=0，是=1

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表 3 BPPV再发患者影响因素logistic回归分析

Table 3. Logistic regression analysis of influencing factors of patients with BPPV recurrence

变量	B	SE	Waldχ²	P值	OR值	95% CI
女性	2.453	0.587	17.445	<0.001	11.623	4.104~20.634
焦虑	1.435	0.645	4.949	0.026	4.200	1.186~14.873
糖尿病	0.144	0.498	0.083	0.773	1.155	0.435~3.066
家族史	0.885	0.492	3.241	0.072	2.423	0.924~6.349
吸烟史	0.613	0.613	1.349	0.245	1.846	0.656~5.192
疲劳	1.614	0.532	9.209	0.002	5.025	1.771~14.255
睡眠障碍	1.406	0.454	9.573	0.002	4.080	1.152~14.447
外伤	1.569	0.688	5.195	0.023	4.802	1.692~13.622
高血压	1.597	0.442	13.032	<0.001	4.938	1.740~14.009

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参考文献(20)

[1]	徐玉玲, 李嘉凯, 田从哲, 等. 良性阵发性位置性眩晕复发的影响因素分析[J]. 医学研究与教育, 2023, 40(4): 45-52. https://www.cnki.com.cn/Article/CJFDTOTAL-XBHB202304008.htm XU Y L, LI J K, TIAN C Z, et al. Analysis of recurrent factors in benign paroxysmal positional vertigo[J]. Medical Research and Education, 2023, 40(4): 45-52. https://www.cnki.com.cn/Article/CJFDTOTAL-XBHB202304008.htm
[2]	KIM H J, PARK J, KIM J S. Update on benign paroxysmal positional vertigo[J]. J Neurol, 2021, 268(5): 1995-2000. doi: 10.1007/s00415-020-10314-7
[3]	李晶. 良性阵发性位置性眩晕症危险因素及氧化应激机制研究[D]. 郑州: 郑州大学, 2023. LI J. Study on risk factors and oxidative stress mechanism of benign paroxysmal positional vertigo[D]. Zhengzhou: Zhengzhou University, 2023.
[4]	COLE S R, HONAKER J A. Benign paroxysmal positional vertigo: effective diagnosis and treatment[J]. Cleve Clin J Med, 2022, 89(11): 653-662.
[5]	姜佩依, 赵婷, 张思然, 等. 神经内科门诊良性阵发性位置性眩晕发病与复发因素分析[J]. 中华耳科学杂志, 2023, 21(4): 458-463. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHER202304003.htm JIANG P Y, ZHAO T, ZHANG S R, et al. Factors for Onset and Recurrence of Benign Paroxysmal Positional Vertigo in Neurology Department[J]. Chinese Journal of Otology, 2023, 21(4): 458-463. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHER202304003.htm
[6]	TU Z H, HE J W, ZHAI Q, et al. Psychometric properties of the brief version of Pittsburgh sleep quality index (B-PSQI) among Chinese male sailors on 18-hr rotating shift schedule[J]. Psychol Assess, 2023, 35(12): 1108-1119. doi: 10.1037/pas0001278
[7]	LI D, FANG P H, LIU H M, et al. The clinical effect of blue light therapy on patients with delayed sleep-wake phase disorder[J]. Nat Sci Sleep, 2022, 14: 75-82. doi: 10.2147/NSS.S344616
[8]	LING X, ZHAO D H, SHEN B, et al. Clinical characteristics of patients with benign paroxysmal positional vertigo diagnosed based on the diagnostic criteria of the Bárány Society[J]. Front Neurol, 2020, 11: 602. doi: 10.3389/fneur.2020.00602
[9]	张晓霞, 冯玲, 梁科, 等. 眩晕残障程度评定量表在HIV/AIDS患者抗病毒治疗中的应用[J]. 医学动物防制, 2021, 37(11): 1063-1066. https://www.cnki.com.cn/Article/CJFDTOTAL-YXDZ202111011.htm ZHANG X X, FENG L, LIANG K, et al. Application of Dizziness Handicap Inventory(DHI)in antiretroviral therapy for HIV/AIDS patients[J]. Journal of Medical Pest Control, 2021, 37(11): 1063-1066. https://www.cnki.com.cn/Article/CJFDTOTAL-YXDZ202111011.htm
[10]	KOÇ A. Benign paroxysmal positional vertigo: is it really an otolith disease?[J]. J Int Adv Otol, 2022, 18(1): 62-70. doi: 10.5152/iao.2022.21260
[11]	杜瑞艳, 贾伟, 李召晨. 头部震动法在水平半规管嵴顶结石BPPV治疗中的临床研究[J]. 卒中与神经疾病, 2023, 30(2): 198-201. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYS202302014.htm DU R Y, JIA W, LI Z C. Clinical study of head vibration method in the treatment of horizontal semicircular canal crest stone BPPV[J]. Stroke and Nervous Diseases, 2023, 30(2): 198-201. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYS202302014.htm
[12]	SINSAMUTPADUNG C, KULTHAVEESUP A. Comparison of outcomes of the Epley and Semont maneuvers in posterior canal BPPV: a randomized controlled trial[J]. Laryngoscope Investig Otolaryngol, 2021, 6(4): 866-871. doi: 10.1002/lio2.619
[13]	李利斌, 孙菊光, 史江峰. Epley法结合针刺快速治疗后半规管原发性良性阵发性位置性眩晕临床分析[J]. 中华全科医学, 2018, 16(12): 2085-2087. doi: 10.16766/j.cnki.issn.1674-4152.000568 LI L B, SUN J G, SHI J F. Clinical analysis of rapid treatment of otolith with manual reduction combined with acupuncture[J]. Chinese Journal of General Practice, 2018, 16(12): 2085-2087. doi: 10.16766/j.cnki.issn.1674-4152.000568
[14]	李玉娟, 刘鹏. 不同性别良性阵发性位置性眩晕患者临床特征分析[J]. 神经损伤与功能重建, 2019, 14(3): 156-158. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF201903017.htm LI Y J, LIU P. Clinical characteristics of benign paroxysmal positional vertigo patients of different genders[J]. Neural Injury and Functional Reconstruction, 2019, 14(3): 156-158. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF201903017.htm
[15]	封红春, 刘锋昌, 刘向利, 等. 良性阵发性位置性眩晕患者焦虑情况及其影响因素分析[J]. 贵州医药, 2021, 45(6): 891-893. https://www.cnki.com.cn/Article/CJFDTOTAL-GZYI202106021.htm FENG H C, LIU F C, LIU X L, et al. Analysis of anxiety and its influencing factors in patients with benign paroxysmal positional vertigo[J]. Guizhou Medical Journal, 2021, 45(6): 891-893. https://www.cnki.com.cn/Article/CJFDTOTAL-GZYI202106021.htm
[16]	NAKATA T, OKADA M, NISHIHARA E, et al. Effect of hormonal therapy on the otoconial changes caused by estrogen deficiency[J]. Sci Rep, 2022, 12(1): 22596. DOI: 10.1038/s41598-022-27240-5.
[17]	ÖZDILEK A, YALINAY DIKMEN P, ACAR E, et al. Determination of anxiety, health anxiety and somatosensory amplification levels in individuals with benign paroxysmal positional vertigo[J]. J Int Adv Otol, 2019, 15(3): 436-441. doi: 10.5152/iao.2019.6874
[18]	YEO B S Y, TOH E M S, LIM N E-K, et al. Association of benign paroxysmal positional vertigo with depression and anxiety: a systematic review and meta-analysis[J]. Laryngoscope, 2023. DOI: 10.1002/lary.30957.
[19]	胡明宇, 许丹芸, 倪恒祥. 抗焦虑药物、甲磺酸倍他司汀片结合前庭康复治疗对良性阵发性位置性眩晕患者的影响[J]. 中外医学研究, 2022, 20(15): 38-42. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY202215010.htm HU M Y, XU D Y, NI H X. Effect of Anti-anxiety Drug and Betahistine Mesylate Tablets Combined with Vestibular Rehabilitation on Patients with Benign Paroxysmal Positional Vertigo[J]. Chinese and Foreign Medical Research, 2022, 20(15): 38-42. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY202215010.htm
[20]	KITAHARA T, HORINAKA A, SHIOZAKI T, et al. Combination of head-up sleep and vertical recognition training may cure intractable motion-evoked dizziness with unknown origin[J]. Acta Otolaryngol, 2020, 140(6): 467-472. doi: 10.1080/00016489.2020.1727566