背景:耳石器官与自主神经系统互补以维持血压。然而,尚未确定自主神经系统血压变异性对耳石器官的影响。本研究旨在验证自主神经系统血压变异性影响良性阵发性位置性眩晕(BPPV)复发的假设。这是前庭器官最常见的疾病,通过使用平视倾斜测试(HUTT)。
方法:本研究包括432例诊断为特发性BPPV的患者。所有患者的随访期均为12个月。年龄,性别,高血压,分析糖尿病和复发情况。将HUTT参数分为一组患者,其中在HUTT(DBP1)期间,与仰卧位相比,直立位的平均舒张压升高;一组患者在HUTT期间,与仰卧位相比,直立位的平均舒张压降低(DBP2)。模型选择,一般对数线性分析,和logit对数线性分析使用分层进行对数线性分析。
结果:总之,平均舒张压(DBP1)升高的组显示BPPV复发的趋势高于在HUTT期间直立时舒张压(DBP2)降低的组,尽管差异无统计学意义(p=0.080)。然而,在男性中,在HUTT期间,DBP1组的BPPV复发率明显高于DBP2组(95%CI,-20.021~-16.200;p<0.001).
结论:据推测,在HUTT期间,通过前庭交感神经反射的自主神经系统反应差维持直立位置的舒张压升高。假定这种变异性影响BPPV的复发。
BACKGROUND: Otolith organ acts complementarily with the autonomic nervous system to maintain blood pressure. However, the effect of blood pressure variability in the autonomic nervous system on otolith organ has not yet been determined. This study aimed to verify the hypothesis that blood pressure variability in the autonomic nervous system affects the recurrence of benign paroxysmal positional vertigo (BPPV), which is the most common disease of the vestibular organs, by using the head-up tilt test (HUTT).
METHODS: This study included 432 patients diagnosed with idiopathic BPPV. The follow-up period for all patients was 12 months. Age, sex, hypertension, diabetes and recurrence were analyzed. The HUTT parameters were divided into a group of patients whose average diastolic blood pressure increased in the upright position compared to supine position during the HUTT (DBP1) and a group of patients whose average diastolic blood pressure decreased in the upright position compared to supine position during the HUTT (DBP2). Model selection, general loglinear analysis, and logit loglinear analysis were performed using a hierarchically progressing loglinear analysis.
RESULTS: In summary, the group with increased average diastolic blood pressure (DBP1) showed a higher tendency for BPPV recurrence compared to the group with decreased diastolic blood pressure (DBP2) in the upright position during the HUTT, although the difference was not statistically significant (p = 0.080). However, in males, the DBP1 group demonstrated a significantly higher recurrence rate of BPPV than the DBP2 group during the HUTT (95% CI, -20.021 to -16.200; p < 0.001).
CONCLUSIONS: It is presumed that poor autonomic nervous system response through vestibulosympathetic reflex maintains elevated diastolic blood pressure in the upright position during the HUTT. This variability is assumed to affect the recurrence of BPPV.