Evidence for vestibular dysfunction in orthostatic hypotension
Evidence for vestibular dysfunction in orthostatic hypotension
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DOI：
10.1007/s00221-011-2989-0
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发表时间：
2012-03-01
影响因子：
2
通讯作者：
Ito, Yatsuji
中科院分区：
文献类型：
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作者：
Aoki, Mitsuhiro;Sakaida, Yuzuru;Ito, Yatsuji
尽管已知前庭系统有助于动物的心血管控制，但几乎没有明确的证据表明前庭-心血管反射在人类中的临床意义。本研究涉及248例头晕患者（127例男性患者和121例女性患者），年龄在65岁及以下。我们根据前庭诱发肌源性电位（VEMP）反应将所有参与者分为三组：无VEMP、不对称VEMP和正常VEMP。为探讨VEMP评估的耳石异常对立位血压反应的影响，在受试者主动站立后进行立位试验，监测受试者的收缩压（SBP）、舒张压（DBP）和心率。无VEMP组男性患者主动站立后1 min舒张压显著下降（P < 0.05），收缩压无变化。而不对称VEMP组和正常VEMP组男性患者主动站立后1 min收缩压均显著升高（P < 0.05）。无VEMP组女性患者站立后血压无明显下降（P > 0.05）。在整个参与者组中，无VEMP组中共有19.6%的患者符合直立性低血压（OH）标准，显著高于正常VEMP组的8.6%和不对称VEMP组的7.2%（P < 0.05）。我们的研究结果表明，前庭障碍，由于功能障碍的耳石器官引起的OH。
There is little definitive evidence of the clinical significance of the vestibular-cardiovascular reflex in humans, despite the fact that the vestibular system is known to contribute to cardiovascular control in animals. The present study involved 248 dizzy patients (127 male patients and 121 female patients) aged 65 years and younger. We classified all participants into three groups based on their vestibular evoked myogenic potential (VEMP) responses; absent VEMP, asymmetry VEMP and normal VEMP. To investigate the effect of the otolith disorder, which was estimated by the VEMP, on the orthostatic blood pressure responses, the subjects' systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate were monitored during the orthostatic test after they actively stood up. The male patients in the absent VEMP group had a significant drop in their DBP at 1 min after active standing up (P < 0.05) without any change in their SBP. Conversely, male patients in the asymmetry VEMP and normal VEMP groups showed a significant increase in the SBP at 1 min after active standing up (P < 0.05). Female patients in the absent VEMP group did not show any significant drop in their blood pressure after standing up (P > 0.05). In the entire group of participants, a total of 19.6% of the patients in the absent VEMP group fulfilled the criteria for orthostatic hypotension (OH), which was significantly > the 8.6% of patients in the normal VEMP group and the 7.2% in the asymmetry VEMP group (P < 0.05). Our results suggest that vestibular disorders due to the dysfunction of otolith organs provoke OH.