【摘要】 目的：分析帕金森病（Parkinson’s disease,PD）患者多维度前庭功能异常在不同Hoehn-Yahr(H-Y)分期中的分布特点，并探讨其与运动症状、平衡功能及外周炎症因子的关系。方法：回顾性纳入2022年6月至2024年6月河北医科大学第一医院神经内科收治的原发性PD患者78例。根据H-Y分期分为早期组（H-Y 1.0～2.5期，45例）和中晚期组（H-Y 3.0～4.0期，33例）。收集一般资料、病程、左旋多巴日等效剂量（levodopa equivalent daily dose,LED）、统一帕金森病评定量表第3部分（Unified Parkinson’s Disease Rating Scale part Ⅲ,UPDRS-Ⅲ）评分、Tinetti步态评分、活动平衡信心量表（Activities-specific Balance Confidence Scale,ABC）及Berg平衡量表评分。前庭功能检查包括双温试验、平稳跟踪、扫视、视动眼震、凝视性眼震、颈性前庭诱发肌源性电位（cervical vestibular-evoked myogenic potential,cVEMP）和眼性前庭诱发肌源性电位（ocular vestibular-evoked myogenic potential,oVEMP）。并检测外周血炎症因子。结果：78例PD患者中，cVEMP异常40例（51.3%）;oVEMP异常40例（51.3%）；任一VEMP异常53例（67.9%）。与早期组比较，中晚期组病程更长，LED和UPDRS-Ⅲ评分更高，Tinetti步态评分、ABC评分及Berg平衡量表评分更低（均P<0.05）。中晚期组cVEMP、oVEMP及视动眼震异常率高于早期组（均P<0.05）。Spearman相关分析显示，H-Y分期与病程、LED、UPDRS-Ⅲ评分、cVEMP异常、oVEMP异常、任一VEMP异常及视动眼震异常呈正相关，与Tinetti步态评分、ABC评分及Berg平衡量表评分呈负相关。cVEMP异常组ABC评分较低，IL-5水平较高；oVEMP异常组H-Y分期和IL-5水平较高。结论：PD患者cVEMP、oVEMP及视动眼震异常可能具有H-Y分期相关特征，提示较高疾病分期患者耳石器-脑干反射通路及视觉-前庭眼动整合异常更为突出。cVEMP异常可能与平衡信心下降有关，oVEMP异常更可能反映较高疾病严重程度相关的前庭-眼动通路受累。IL-5与VEMP异常的关系仅为探索性发现，仍需进一步验证。更多还原

【Abstract】 Objective:To analyze the distribution patterns of multidimensional vestibular dysfunction across different Hoehn-Yahr(H-Y) stages in patients with Parkinson’s disease(PD),and to explore its associations with motor symptoms,balance function,and peripheral inflammatory cytokines.Methods:A total of 78patients with idiopathic PD admitted to the Department of Neurology,the First Hospital of Hebei Medical University,from June 2022 to June 2024 were retrospectively enrolled.According to the H-Y stage,the patients were divided into an early-stage group(H-Y stages 1.0-2.5,n=45) and a middle-to-advanced-stage group(H-Y stages 3.0-4.0,n=33).General clinical data,disease duration,levodopa equivalent daily dose(LED),Unified Parkinson’s Disease Rating Scale part Ⅲ(UPDRS-Ⅲ) score,Tinetti gait score,Activities-specific Balance Confidence Scale(ABC) score,and Berg Balance Scale score were collected.Vestibular function tests included caloric testing,smooth pursuit,saccade testing,optokinetic nystagmus,gaze-evoked nystagmus,cervical vestibular-evoked myogenic potential(cVEMP),and ocular vestibular-evoked myogenic potential(oVEMP).Peripheral blood inflammatory cytokines were also measured.Results:In the 78 patients with PD,cVEMP abnormalities were observed in 40 patients(51.3%),oVEMP abnormalities in 40 patients(51.3%),and any VEMP abnormality in 53 patients(67.9%).Compared with the early-stage group,the middle-to-advanced-stage group had a longer disease duration,higher LED and UPDRS-Ⅲ scores,and lower Tinetti gait,ABC,and Berg Balance Scale scores(all P<0.05).The rates of cVEMP,oVEMP,and optokinetic nystagmus abnormalities were higher in the middle-to-advanced-stage group than in the early-stage group(all P<0.05).Spearman correlation analysis showed that H-Y stage was positively correlated with disease duration,LED,UPDRS-Ⅲ score,cVEMP abnormality,oVEMP abnormality,any VEMP abnormality,and optokinetic nystagmus abnormality,and negatively correlated with Tinetti gait,ABC,and Berg Balance Scale scores.Patients with cVEMP abnormalities had lower ABC scores and higher interleukin-5(IL-5) levels,whereas patients with oVEMP abnormalities had more advanced H-Y stages and higher IL-5 levels.Conclusion:The abnormalities of cVEMP,oVEMP,and optokinetic nystagmus in PD patients may exhibit features correlated with Hoehn-Yahr(H-Y) staging,suggesting that dysfunction in the otolith-brainstem reflex pathway and visual-vestibular oculomotor integration is more pronounced in patients at higher disease stages.cVEMP abnormalities may be associated with reduced balance confidence,whereas oVEMP abnormalities are more likely to reflect the involvement of the vestibulo-ocular pathway associated with greater disease severity.The association between IL-5 and VEMP abnormalities remains an exploratory finding and requires further validation.更多还原