持续性姿势–知觉性头晕的病理机制与整合治疗新视角

A New Perspective on the Pathogenesis and Integrated Treatment of Persistent Postural-Perceptual Dizziness

摘要: 持续性姿势–知觉性头晕(Persistent Postural-Perceptual Dizziness, PPPD)是一种以长期、非旋转性主观头晕及失衡感为特征的慢性前庭功能障碍，病程常迁延数月乃至数年，对患者的日常生活质量构成严重挑战。近年来，PPPD在眩晕专科门诊中的就诊比例显著攀升，其发病与现代社会的高压环境及心理因素关联密切。临床观察显示，PPPD患者常共病焦虑、抑郁及睡眠障碍，提示其本质为一种典型的身心交互性疾病。尽管病理机制尚未完全阐明，但现有研究普遍认为，前庭系统、视觉系统与本体感觉系统在中枢层面的整合失调，叠加个体固有的高焦虑人格特质，共同构成了疾病发生与持续的基石。当前治疗策略趋向于多模式整合，涵盖药物干预、前庭康复训练及中医特色疗法，旨在多靶点缓解眩晕、改善情绪并促进功能恢复。本文系统梳理了PPPD的病因、病理生理假说及各类治疗手段的循证依据，重点探讨了中西医结合并辅以心理干预的综合治疗模式。分析表明，单一疗法虽有一定疗效，但常面临疗程长、易复发的局限。而整合中西医优势，结合心理治疗，实现“身心同治”，不仅能显著提升临床疗效，更能为患者提供更具精准性与个性化的医疗方案，是未来PPD治疗发展的重要方向。

Abstract: Persistent Postural-Perceptual Dizziness (PPPD) is a chronic vestibular disorder characterized by long-term, non-rotational subjective dizziness and a sense of imbalance. The condition often persists for months or even years, posing a significant challenge to patients’ quality of daily life. In recent years, the proportion of PPPD patients in vertigo specialty clinics has risen significantly, a trend closely associated with the high-pressure environment of modern society and psychological factors. Clinical observations show that PPPD patients frequently suffer from comorbidities such as anxiety, depression, and sleep disorders, suggesting that the condition is fundamentally a typical psychosomatic disorder. Although its pathological mechanisms are not yet fully understood, current research generally holds that a central integration dysfunction of the vestibular, visual, and somatosensory systems, combined with an individual’s inherent high-anxiety personality traits, forms the foundation for the onset and persistence of the disease. Current treatment strategies are trending towards multimodal integration, encompassing pharmacological interventions, vestibular rehabilitation training, and traditional Chinese medicine (TCM) therapies, aiming to alleviate dizziness, improve mood, and promote functional recovery through multiple targets. This article systematically reviews the etiology, pathophysiological hypotheses, and evidence-based support for various treatment modalities for PPPD, with a particular focus on the integrated treatment model combining Western and Chinese medicine supplemented by psychological interventions. The analysis indicates that while single therapies may have some efficacy, they often face limitations such as prolonged treatment courses and high recurrence rates. By contrast, integrating the strengths of both Western and Chinese medicine with psychological therapy to achieve “simultaneous treatment of body and mind” can not only significantly enhance clinical efficacy but also provide patients with more precise and personalized medical solutions, representing a key direction for the future development of PPPD treatment.