摘要目的:探讨基于Bárány协会诊断标准纳入的运动病（MSD）患者半规管与耳石重力通路功能改变及可能的发病机制。方法:病例对照研究。纳入2022年3至8月招募的20例MSD患者（MSD组）及20名性别、年龄相匹配，无MSD病史的健康对照（对照组），在航天中心医院完成研究。所有受试者均完成运动不耐受易感性问卷简版（MSSQ-short）、运动不耐受评估问卷（MSAQ），完善基于半规管功能的双温试验、视频头脉冲试验（vHIT）和耳石重力通路功能的主观视觉垂直/水平（SVV/SVH）、前庭诱发肌源性电位（VEMP）的功能评价，分析MSD患者前庭功能改变情况，并进一步探讨MSD可能的发病机制。结果:每组20例受试者中，男9例，女11例；MSD组年龄（26.9±3.9）岁，对照组年龄（27.0±3.4）岁。MSD组MSSQ-short得分［27.0（22.5，38.8）分比1.2（0，3.2）分， P<0.001］和MSAQ得分［70.1（54.5，78.1）分比11.8（11.1，13.9）分， P<0.001］均高于对照组。半规管功能评价结果显示，MSD患者双温试验不耐受的发生率（60.0%，12/20）高于对照组（20.0%，4/20）（ P=0.010）。耳石重力通路评价结果显示，SVV、SVH、颈性VEMP（cVEMP）异常率两组差异均无统计学意义（均 P>0.05）。MSD组眼性VEMP（oVEMP）异常率（55.0%，11/20）高于对照组（10.0%，2/20）（ P=0.002），其中P1波潜伏期较对照组延迟［（18.4±1.2）ms比（17.6±0.8）ms， P=0.018］。相关性分析结果显示，oVEMP的P1波潜伏期与MSSQ-short（ r=0.486， P=0.002）、MSAQ（ r=0.391， P=0.015）得分及双温不耐受症状持续时间（ r=0.377， P=0.004）均呈正相关。 结论:MSD患者存在半规管刺激的高敏及耳石器潜伏期延迟受损，提示半规管和耳石器功能“分离”现象，可能参与MSD感觉冲突的发生。

abstractsObjective:To investigate the altered function of the semicircular canal and otolith graviceptive pathway in patients diagnosed with motion sickness disorder (MSD) based on the diagnostic criteria of the Bárány society, and explore its relevance to the pathogenesis of MSD.Methods:This is a case-control study. Twenty patients with MSD and age-and sex-matched healthy controls without a history of MSD from the Department of Neurology of Aerospace Center Hospital between March and August 2022 were recruited. All subjects completed the motion sickness susceptibility questionnaire-short version (MSSQ-short) and the motion sickness assessment questionnaire (MSAQ). Canal function was evaluated using caloric stimulation test and video head impulse test (vHIT), and subjective visual vertical/horizontal (SVV/SVH) and vestibular evoked myogenic potential (VEMP) were employed to assess otolith graviceptive function. Differences in vestibular function and correlations between the two groups were analyzed.Results:Each group consisted of 20 cases (9 males and 11 females). The mean age of the MSD and control groups was (26.9±3.9) years and (27.0±3.4) years, respectively. The scores of MSSQ-short [27.0 (22.5, 38.8) vs 1.2 (0, 3.2), P<0.001] and MSAQ [70.1 (54.5, 78.1) vs 11.8 (11.1, 13.9), P<0.001] were significantly higher in the MSD group compared with those of the control group. Evaluation of canal function revealed a significantly higher incidence of caloric stimulation intolerance in MSD patients (60.0%, 12/20) compared with that of the control group (20.0%, 4/20) ( P=0.010). Evaluation of otolith graviceptive pathway indicated no significant difference in SVV, SVH and cervical VEMP (cVEMP) abnormality rates between the two groups (all P>0.05). The ocular VEMP (oVEMP) abnormality rate was significantly higher in the MSD group (55.0%, 11/20) than that of the control group (10.0%, 2/20) ( P=0.002), with a delayed P1-wave latency compared with the control group [(18.4±1.2) ms vs (17.6±0.8) ms, P=0.018]. Further correlation analysis revealed that P1-wave latency in oVEMP was positively correlated with MSSQ-short ( r=0.486, P=0.002) and MSAQ ( r=0.391, P=0.015) scores, and duration of caloric intolerance symptoms ( r=0.377, P=0.004). Conclusion:The presence of hypersensitivity to caloric stimulation and delayed latency of otolith function in patients with MSD suggests a "separation" between semicircular canal and otolithic function, which may be related to sensory conflict.