脑小血管病与老年慢性头晕的关系研究

A Study on the Relationship between Cerebral Small Vessel Disease and Chronic Dizziness in the Elderly

摘要: 目的：研究老年人群脑小血管病白质病变程度和总体负担评分与头晕的关系。方法：选取2021年1月~2022年12月期间，于烟台毓璜顶医院神经内科住院治疗的≥60岁的慢性头晕患者，根据前庭疾病国际分类中慢性前庭综合征的定义，头晕定义为头晕、眩晕、非特异性不稳感或多种症状同时存在，且症状持续3个月以上。分为已知病因组(符合前庭疾病国际分类中慢性前庭综合征的病因，如持续性姿势–知觉性头晕，单侧前庭病，双侧前庭病，老年性前庭病，小脑变性及后颅凹肿瘤等)和脑小血管病组(cerebral small vessel disease, CSVD) (没有上述病因但头颅核磁共振检查符合CSVD的诊断标准)。所有患者均进行眩晕障碍量表(Dizziness Handicap Inventory, DHI)评分、视觉模拟尺(Visual Analog Scale, VAS)评分及脑白质高信号和CSVD总体负担评分。采用SPSS26.0软件进行统计学处理，分析脑小血管病与头晕的关系，以及脑白质高信号和CSVD总体负担评分与头晕的相关性。结果：CSVD组的CSVD总体负担评分显著高于已知病因组，两者之间差异有统计学意义(P < 0.05)，而且随着脑白质病变程度及CSVD总体负担评分增高，DHI头晕量表及VAS评分也增高(P < 0.05)。结论：脑小血管病与老年慢性头晕的发生存在相关性，随着脑小血管病程度的加重，头晕程度会随之加深。对于病因不明且已经过临床和前庭评估的老年头晕患者，应尽早进行脑核磁成像以评估有无CSVD，以明确诊断并指导治疗。

Abstract: Objective: To study the relationship between the severity of cerebral small vessel disease and chronic dizziness in the elderly. Methods: Taking prospective study of patients suffering from chronic dizziness aged ≥ 60 years old, in January 2021-December 2022 in Yantai Yuhuangding Hospital neurology, divided into known cause group (according to the international classification of chronic vestibular syndrome, such as persistent posture-perception dizziness, unilateral vestibular, bilateral vestibular, senile vestibular, cerebellar degeneration and posterior cranial concave tumor, etc.) and CSVD group (without the above etiology but brain MRI meet the diagnostic criteria of CSVD). All patients received DHI (Dizziness Handicap Inventory) scale score, visual analog ruler (Visual Analog Scale, VAS), and Fazekas score and CSVD overall burden score for the CSVD group. Statistical processing was performed by using the SPSS26.0 software. To compare whether there was a statistical difference in CSVD overall burden score between the two groups, and the correlation between CSVD overall burden score and dizziness severity. Results: The overall burden of CSVD in the CSVD group was significantly higher than that in the known etiology group (P < 0.05), but the DHI and VAS scores were similar to that of the known etiology group. With the CSVD overall burden score increase, the DHI and VAS scores also increased, which showed some correlation (P < 0.05). Conclusion: There is a correlation between cerebral small vessel disease and the occurrence of dizziness symptoms, and the degree of dizziness will deepen as the degree of cerebral small vessel disease increases. For elderly patients with dizziness of unknown etiology who have undergone clinical and vestibular assessments, brain MRI should be performed as early as possible to assess the presence of CSVD.