目的 探讨神经内科门诊就诊的中老年头晕/眩晕患者的病因分布。方法 回顾性分析于2021年3-9月就诊于北京朝阳医院京西院区神经内科的中老年头晕/眩晕患者1931例,分为老年组(＞60岁)1005例和中年组(40～60岁)926例,对两组人口学特征、性别分布及病因分布相关数据进行分析。结果 分析以头晕/眩晕为主诉的老年患者病因分布,发现前3位的病因依次为良性发作性位置性眩晕(benign paroxysmal positional vertigo,BPPV)29.9%、精神心理性头晕/持续性姿势-感知性头晕(psychiatric or persistent postural perceptual dizziness, psychogenic/PPPD)28.7%及血管源性头晕20.0%;中年头晕/眩晕患者以BPPV最常见(33.2%),其次是精神心理性头晕/PPPD(30.9%)及前庭性偏头痛(10.0%);中年及老年头晕/眩晕患者病因构成差异有统计学意义,其中血管源性头晕在老年人群中更常见,前庭性偏头痛在中年人群更常见。中年及老年人群中BPPV、精神心理性头晕/PPPD均为女性多于男性(P<0.05),中年人前庭性偏头痛中女性占优势(P<0.05),而在中年人血管源性头晕中男性占优势(P=0.00)。结论 中年及老年头晕/眩晕患者中最常见的病因为BPPV及精神心理性头晕/PPPD,均以女性常见。对于不明原因的老年头晕患者要注意血管源性头晕的识别,特别是脑小血管病。对于反复发作性头晕的中年女性患者不能忽视前庭性偏头痛的可能。
Abstract
Objective To investigate the etiological distribution of middle-aged and elderly patients with dizziness/vertigo in neurology outpatient department.Methods The data of middle-aged and elderly patients with dizziness/vertigo who visited the neurology department were retrospectively reviewed to understand the demographic characteristics, gender distribution and etiological distribution.Results The top three causes of dizziness/vertigo were BPPV (29.9%), psychogenic/PPPD (28.7%), and vascular vertigo (20.0%) in the elderly and BPPV (33.2%), psychogenic/PPPD (30.9%), and vestibular migraine (10.0%) in the middle-aged. Compared with the middle-aged, the etiological distribution of the elderly had changed significantly (P=0.000). Vascular vertigo was more common in the elderly (P=0.000), while vestibular migraine was more common in the middle-aged. BPPV and psychogenic/PPPD(P<0.05) were more common in the middle-aged and elderly women patients, and vestibular migraine (P<0.05) was more common in the middle-aged women patients, while vascular vertigo showed a male predominance in the middle-aged(P=0.00).Conclusions BPPV and psychogenic/PPPD are the most common causes of dizziness/vertigo in middle-aged and elderly patients, and both are more common in women. More attention should be paid to the possibility of small cerebral vascular disease in elderly patients with unexplained dizziness. The diagnosis of vestibular migraine should be taken seriously for the elderly female patients with recurrent dizziness.
关键词
头晕/眩晕 /
中老年 /
良性发作性位置性眩晕 /
精神心理性头晕/持续性姿势-感知性头晕 /
前庭性偏头痛 /
血管源性头晕
Key words
dizziness/vertigo /
elderly /
BPPV /
psychogenic /
vestibular migraine /
vascular vertigo
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