目的：探讨儿童复发性眩晕(RVC)的可能发病机制及前庭诱发肌源性电位(VEMPs)的临床诊断价值。
方法：收集2017年4月至2021年2月纳入对照组（NC）的19例（5.95±0.38岁）RVC患儿和17例（5.35±0.31岁）正常儿童的临床资料。测试所有受试者的宫颈VEMP(cVEMP)和眼部VEMP(oVEMP)。引发率，阈值，N1延迟,P1延迟，间隔,振幅,比较分析两组VEMPs的振幅不对称率(AAR)。
结果：（1）两组cVEMP和oVEMP的诱发率无统计学差异（P>0.05）。(2)RVC组cVEMP和oVEMP阈值均高于NC组(P<0.05)。（3）RVC组cVEMP的N1潜伏期长于NC组（P<0.05）。cVEMP的P1潜伏期和oVEMP的潜伏期在两组间差异无统计学意义(P>0.05)。(4)RVC组cVEMP间隔时间长于NC组(P<0.05),而oVEMP间隔时间两组间差异无统计学意义(P>0.05)。(5)RVC组cVEMP振幅高于NC组(P<0.05),而oVEMP的振幅在两组中相似(P>0.05)。(6)两组oVEMP和cVEMP的AAR值相似(P>0.05)。
结论：RVC患儿的VEMPs发生率与正常儿童无差异，但是门槛都提高了，提示耳石器官和前庭神经传导通路的敏感性降低。RVC患儿cVEMPP1潜伏期正常,但是cVEMP的N1潜伏期和间隔期增加，我们最终得出结论，在RVC中可能存在前庭下神经和随后的神经传导通路的潜在损害。
OBJECTIVE: To explore the possible pathogenesis of recurrent vertigo of childhood (RVC) and the clinical diagnosis value of vestibular-evoked myogenic potentials (VEMPs).
METHODS: The clinical data of 19 children (5.95 ± 0.38 years) diagnosed with RVC and 17 normal children (5.35 ± 0.31 years) enrolled in the control (NC) group from April 2017 to February 2021 was collected and analyzed. All subjects were tested for both cervical VEMP (
cVEMP) and ocular VEMP (oVEMP). The elicit rate, thresholds, N1 latency, P1 latency, interval, amplitude, and amplitude asymmetry ratio (AAR) of VEMPs were compared and analyzed between the two groups.
RESULTS: (1) The elicit rates of
cVEMP and oVEMP have no significant difference between the two groups (P > 0.05). (2) The thresholds of
cVEMP and oVEMP in the RVC group were higher than that in the NC group (P < 0.05). (3) The N1 latency of
cVEMP in the RVC group was longer than that in the NC group (P < 0.05). The P1 latency of cVEMP and latencies of oVEMP have no significant difference between the two groups (P > 0.05). (4) The interval of cVEMP in the RVC group was longer than that in the NC group (P < 0.05), while the interval of oVEMP has no significant difference between the two groups (P > 0.05). (5) The amplitude of cVEMP in the RVC group was higher than that in the NC group (P < 0.05), while the amplitude of oVEMP was similar in the two groups (P > 0.05). (6) The AAR values of oVEMP and cVEMP were similar in the two groups (P > 0.05).
CONCLUSIONS: The elicit rates of VEMPs in children with RVC did not differ from that of normal children, but the thresholds were all increased, suggesting reduced sensitivity of the otolith organ and vestibular nerve conduction pathways. The P1 latency of
cVEMP was normal in children with RVC, but N1 latency and interval of
cVEMP were increased, we finally reached a conclusion that there might be potential impairment in the inferior vestibular nerve and the subsequent nerve conduction pathway in RVC.
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