【摘要】 目的 了解原發(fā)性良性陣發(fā)性位置性眩暈（benign paroxysmal positional vertigo，BPPV）的雙溫試驗(yàn)及純音測(cè)聽(tīng)結(jié)果臨床特點(diǎn)。 方法 2009年6月—2010年6月診斷為原發(fā)性BPPV患者54例，于手法復(fù)位前行雙溫試驗(yàn)及純音聽(tīng)閾測(cè)試，分析原發(fā)性BPPV患者的雙溫試驗(yàn)、純音測(cè)聽(tīng)結(jié)果的臨床特點(diǎn)?！〗Y(jié)果 40例患耳無(wú)半規(guī)管輕癱，其病程為（4.25±2.75）周，14例患耳半規(guī)管輕癱，其病程為（9.21±5.85）周，兩組間平均病程差異具有統(tǒng)計(jì)學(xué)意義（t=4.235，Plt;0.05）；39例后半規(guī)管BPPV中11例患耳半規(guī)管輕癱，15例水平半規(guī)管BPPV中3例患耳半規(guī)管輕癱，兩組患耳半規(guī)管輕癱發(fā)生率無(wú)統(tǒng)計(jì)學(xué)意義（χ2=2.679，Pgt;0.05）；39例后半規(guī)管BPPV中16例患耳聽(tīng)力下降，15例水平半規(guī)管BPPV中7例患耳聽(tīng)力下降，兩組患耳純音測(cè)聽(tīng)異常率無(wú)明顯統(tǒng)計(jì)學(xué)差異（χ2=0.141，Pgt;0.05）。 結(jié)論 原發(fā)性后半規(guī)管BPPV與水平半規(guī)管BPPV半規(guī)管輕癱及純音聽(tīng)閾異常發(fā)生率相近，病程長(zhǎng)者更易出現(xiàn)半規(guī)管輕癱?！続bstract】 Objective To investigate the clinical features of results of bithermal test and pure tone test for patients with idiopathic benign paroxysmal positional vertigo (BPPV), and discuss strategies for prevention. Methods A total of 54 patients diagnosed to have BPPV during June 2009 to June 2010 underwent bithermal caloric test and pure tone test before particle repositioning maneuver. Then, we analyzed the clinical features of the test results. Results The course of 40 patients with canal paresis (CP) was (4.25±2.75) weeks, which had a significant difference from the course of 14 patients with CP in the abnormal side, which was (9.21±5.85) weeks (t=4.235, Plt;0.05). Among the 39 patients with posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV), 11 cases of canal paresis were found in the abnormal ear, and of the 15 patients with horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV), 3 cases of canal paresis were found. There was no statistical difference in the rate of canal paresis between the two groups of patients mentioned above (χ2=2.679,Pgt;0.05). Sixteen out of the 39 PSC-BPPV patients and seven out of the 15 HSC-BPPV patients had hearing loss (HL) in the abnormal ear with no statistical difference between the two groups of patients in the incidence of hearing loss (χ2=0.141,Pgt;0.05). Conclusion The incidence of CP and HL in the abnormal ear of patients with HSC-BPPV and PSC-BPPV is similar, and patients with long course of disease are more likely to have CP.
目的 探討統(tǒng)一診斷標(biāo)準(zhǔn)對(duì)乳腺導(dǎo)管增生性病變?cè)\斷重復(fù)性的影響,尋求提高病理診斷可重復(fù)性和準(zhǔn)確性的措施.方法 參照Page標(biāo)準(zhǔn)收集43例乳腺導(dǎo)管增生性病變,每例選取一張切片并隨機(jī)排序.10位病理醫(yī)師兩兩配對(duì)后隨機(jī)進(jìn)入試驗(yàn)組(統(tǒng)一診斷標(biāo)準(zhǔn)組)和對(duì)照組,各自獨(dú)立讀片后從輕度普通型增生、中-重度普通型增生、輕度非典型增生、中-重度非典型增生、導(dǎo)管原位癌和導(dǎo)管原位癌伴浸潤(rùn)這6種診斷中選取一種,并采用STATA統(tǒng)計(jì)軟件對(duì)兩組病理醫(yī)師間的診斷重復(fù)性進(jìn)行Kappa分析.同時(shí)以?xún)晌蝗橄賹?zhuān)科病理醫(yī)師按照Page標(biāo)準(zhǔn)確認(rèn)的診斷作為參照,對(duì)兩組病理醫(yī)師診斷的準(zhǔn)確性和過(guò)度診斷進(jìn)行統(tǒng)計(jì)學(xué)分析.結(jié)果 統(tǒng)一使用Page標(biāo)準(zhǔn)的試驗(yàn)組的診斷重復(fù)性和準(zhǔn)確性均高于對(duì)照組(兩組6種、3種和2種診斷時(shí)的總K值分別為0.289 3,0.337 1,0.492 8和0.100 3,0.150 3,0.340 5),說(shuō)明統(tǒng)一診斷標(biāo)準(zhǔn)有利于提高診斷重復(fù)性.同時(shí),診斷類(lèi)別簡(jiǎn)化也提高了診斷的可重復(fù)性.試驗(yàn)組醫(yī)師仍存在不同程度的過(guò)度診斷.結(jié)論 統(tǒng)一診斷標(biāo)準(zhǔn)是提高病理診斷可重復(fù)性和準(zhǔn)確性的重要措施;對(duì)診斷標(biāo)準(zhǔn)的掌握需要在實(shí)踐中進(jìn)一步提高.