甲磺酸倍他司汀治疗眩晕症的专家共识

doi:10.12114/j.issn.1007-9572.2023.0312

摘要/Abstract

摘要： 为规范眩晕症的科学用药，中国医药教育协会眩晕专业委员会特成立专家小组，在纳入现有医学科学证据的基础上，结合专家丰富的临床经验，经反复讨论后形成《甲磺酸倍他司汀治疗眩晕症的专家共识》。本共识包括组胺类药物的药理基础以及甲磺酸倍他司汀在常见眩晕疾病（如良性阵发性位置性眩晕、梅尼埃病、前庭神经炎等）中的用药推荐等级、剂量、疗程、复查方法、特殊人群用药、药物不良反应等方面，旨在帮助医生提升临床实践水平。

关键词: 眩晕, 良性阵发性位置性眩晕, 梅尼埃病, 前庭神经元炎, 倍他司汀, 临床用药

Abstract:

In order to standardize scientific drug use in vertigo, the Vertigo Committee of the Chinese Medical Education Association established an expert group to form Expert Consensus on Betahistine Mesylate in the Treatment of Vertigo after repeated discussion based on the existing medical evidence, and combined with the rich clinical experience of experts. The consensus includes the pharmacological basis of histamines, the strength of recommendation, dosage, course, review methods, medication for special populations, adverse drug reactions and other aspects of betahistine mesylate in common vertigo diseases (such as benign paroxysmal position vertigo, Menieres disease, and vestibular neuritis, etc.) to guide doctors in clinical work.

Key words: Vertigo, Benign paroxysmal positional vertigo, Meniere disease, Vestibular neuronitis, Betahistine, Clinical medication

中国医药教育协会眩晕专业委员会. 甲磺酸倍他司汀治疗眩晕症的专家共识[J]. 中国全科医学, 2023, 26(29): 3591-3598. DOI: 10.12114/j.issn.1007-9572.2023.0312.
The Vertigo Committee of the Chinese Medical Education Association. Expert Consensus on Betahistine Mesylate in the Treatment of Vertigo[J]. Chinese General Practice, 2023, 26(29): 3591-3598. DOI: 10.12114/j.issn.1007-9572.2023.0312.

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参考文献 73

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推荐强度（级）	等级释义及临床建议
A	强。循证证据肯定或良好（Ⅰ~Ⅱ级）；或循证证据一般（Ⅲ~Ⅳ级），但在国内外指南中明确推荐。能够改善健康结局，利大于弊
B	中等。循证证据一般（Ⅲ~Ⅳ级）。可以改善健康结局
C	弱。循证证据不足或矛盾（Ⅴ~Ⅹ级）。无法明确利弊，但可能改善健康结局

推荐强度（级）	等级释义及临床建议
A	强。循证证据肯定或良好（Ⅰ~Ⅱ级）；或循证证据一般（Ⅲ~Ⅳ级），但在国内外指南中明确推荐。能够改善健康结局，利大于弊
B	中等。循证证据一般（Ⅲ~Ⅳ级）。可以改善健康结局
C	弱。循证证据不足或矛盾（Ⅴ~Ⅹ级）。无法明确利弊，但可能改善健康结局

证据等级（级）	分级释义
Ⅰ	基于多个随机对照试验的荟萃分析或系统评价；大样本的随机试验
Ⅱ	基于至少1个质量较高的随机对照试验；设计规范、结果明确的观察性研究或横断面研究；前瞻性队列研究
Ⅲ	基于设计良好的非随机性病例对照研究，观察性研究，非前瞻性队列研究
Ⅳ	基于非随机性回顾性研究；专家共识
Ⅴ	病例报告；基于机制的推理或基于基本原则的推理
Ⅹ	特殊情况无法进行验证但益处明显超过危害，或证据存在矛盾

证据等级（级）	分级释义
Ⅰ	基于多个随机对照试验的荟萃分析或系统评价；大样本的随机试验
Ⅱ	基于至少1个质量较高的随机对照试验；设计规范、结果明确的观察性研究或横断面研究；前瞻性队列研究
Ⅲ	基于设计良好的非随机性病例对照研究，观察性研究，非前瞻性队列研究
Ⅳ	基于非随机性回顾性研究；专家共识
Ⅴ	病例报告；基于机制的推理或基于基本原则的推理
Ⅹ	特殊情况无法进行验证但益处明显超过危害，或证据存在矛盾

指标		H₁受体	H₂受体	H₃受体	H₄受体
偶联G蛋白		Gq/11	Gs	Gi/o	Gi/o
下游信号转导通路		PLC，IP₃，DAG，Ca²⁺，PKC，AMPK，NF-κB	AC，cAMP，PKA，CREB	AC↓，cAMP↓，MAPK，Akt/GSK3	AC↓，cAMP↓，MAPK
细胞功能		突触后兴奋	突触后兴奋	突触前抑制	尚不明确
分布	相关脑区	丘脑，大脑皮质，海马，隔核，背侧丘脑，基底前脑，蓝斑，缝核，下丘脑，杏仁核，小脑，孤束核，延髓最后区	海马，基底节，杏仁核，蓝斑，缝核，黑质，丘脑，下丘脑，大脑皮质，小脑	大脑皮质，纹状体，伏隔核，基底节，下丘脑，海马，小脑	中枢非神经元
	前庭系统	半规管壶腹嵴，耳石器囊斑，内淋巴囊，前庭神经核	半规管壶腹嵴，耳石器囊斑，内淋巴囊，前庭神经核	半规管壶腹嵴，耳石器囊斑，内淋巴囊，前庭神经节，前庭神经核	耳石器囊斑，内淋巴囊，前庭神经节，前庭神经核
影响前庭功能的可能机制		（1）中枢觉醒水平；（2）前庭神经核兴奋性；（3）耳蜗微循环	前庭神经核兴奋性	（1）中枢觉醒水平；（2）中枢组胺的合成与释放；（3）前庭神经核兴奋性；（4）前庭神经兴奋性；（5）耳蜗微循环	前庭神经兴奋性