前庭康复联合药物治疗对急性前庭神经炎患者前庭功能恢复及氧化应激水平的影响

Effects of vestibular rehabilitation combined with pharmacotherapy on recovery of vestibular function and oxidative stress in patients with acute vestibular neuritis

摘要:

目的 探讨前庭康复联合药物治疗对急性前庭神经炎患者前庭功能恢复及氧化应激水平的影响。方法 回顾性分析2021年9月—2023年11月在国药东风总医院诊治的106例急性前庭神经炎患者的临床资料，按治疗方法分为联合组与药物组，各53例。药物组接受常规药物治疗并给予基础前庭康复指导，联合组在药物组基础上给予前庭康复训练。比较两组的临床疗效、治疗前后前庭功能［自发性眼震慢相角速度（SN-SPV）、半规管轻瘫值（CP）、优势偏向值（DP）、颈肌前庭诱发肌源性电位（cVEMP）］、氧化应激反应［超氧化物歧化酶（SOD）、25-羟基维生素D₃［25（OH）D?］、8-羟基脱氧鸟苷（8-OHdG）、谷胱甘肽（GSH）］、前庭症状［采用日常活动前庭功能障碍等级（VADL）、Berg平衡量表（BBS）、眩晕障碍量表（DHI）］及生活质量［世界卫生组织生存质量测定量表简表（WHOQOL-BREF）］。结果 联合组治疗总有效率高于药物组（P <0.05）。联合组治疗后SN-SPV、CP、DP、p1波潜伏期、n1波潜伏期均低于药物组，p1-n1振幅高于药物组（P <0.05），联合组治疗前后SN-SPV、CP、DP、p1波潜伏期、n1波潜伏期、p1-n1振幅的差值均大于药物组（P <0.05）。联合组治疗后SOD、25（OH）D?、GSH均高于药物组，8-OHdG低于药物组联合组（P <0.05），联合组治疗前后SOD、25(OH)D?、8-OHdG、GSH的差值均大于药物组（P <0.05）。联合组治疗后BBS评分高于药物组，VADL、DHI评分均低于药物组（P <0.05），联合组治疗前后VADL、DHI、BBS评分的差值均大于药物组（P <0.05）。联合组治疗后身体、心理、社会关系、环境维度评分均高于药物组（P <0.05），联合组治疗前后身体、心理、社会关系、环境维度评分的差值均大于药物组（P <0.05）。结论 前庭康复联合药物治疗可显著改善急性前庭神经炎患者的前庭功能，降低氧化应激水平，并提高生活质量。

Abstract:

Objective To explore the effects of vestibular rehabilitation combined with pharmacotherapy on recovery of vestibular function and oxidative stress levels in patients with acute vestibular neuritis.Methods A retrospective study was conducted on 106 patients with acute vestibular neuritis treated at Guoyao Dongfeng General Hospital from September 2021 to November 2023. Patients were divided into the combination group (n = 53) and the medication group (n = 53) according to treatment. The medication group received conventional drug therapy and basic vestibular rehabilitation guidance, the combination group received vestibular rehabilitation exercises in addition to the regimen used in the medication group. The clinical efficacy, vestibular function [slow-phase velocity of spontaneous nystagmus (SN-SPV), canal paresis value (CP), directional preponderance (DP), cervical vestibular-evoked myogenic potentials (cVEMP)], vestibular symptoms [Vestibular Activities of Daily Living Scale (VADL), Berg balance scale (BBS), dizziness handicap inventory (DHI)], oxidative stress response [superoxide dismutase (SOD), 25-hydroxyvitamin D₃ (25(OH)D₃), 8-hydroxy-2'-deoxyguanosine (8-OHdG), glutathione (GSH)], and quality of life [World Health Organization Quality of Life-BREF (WHOQOL-BREF)] were compared between the two groups.Results The total effective rate in the combination group was significantly higher than that in the medication group (P < 0.05). After treatment, the combination group exhibited significantly lower values of SN-SPV, CP, DP, p1 latency, and n1 latency, as well as a significantly higher p1-n1 amplitude compared with the medication group (all P < 0.05). Moreover, the pre-to-post treatment differences (Δ values) in SN-SPV, CP, DP, p1 latency, n1 latency, and p1-n1 amplitude were all significantly greater in the combination group than in the medication group (all P < 0.05). Regarding oxidative stress markers, the combination group showed significantly higher levels of SOD, 25(OH)D₃, and GSH, and a significantly lower level of 8-OHdG compared with the medication group after treatment (all P < 0.05). The pre-to-post treatment differences in SOD, 25(OH)D₃, 8-OHdG, and GSH were also significantly greater in the combination group than in the medication group (all P < 0.05). In terms of functional assessments, the combination group achieved a significantly higher BBS score and significantly lower VADL and DHI scores compared with the medication group after treatment (all P < 0.05). The pre-to-post treatment differences in VADL, DHI, and BBS scores were all significantly greater in the combination group than in the medication group (all P < 0.05). Regarding quality of life, the combination group had significantly higher scores in the physical, psychological, social relationships, and environmental domains compared with the medication group after treatment (all P < 0.05). The pre-to-post treatment differences in these four domain scores were also significantly greater in the combination group than in the medication group (all P < 0.05).Conclusion Vestibular rehabilitation combined with drug therapy significantly improves vestibular function and decreases oxidative stress levels, and improves quality of life in patients with acute vestibular neuritis.