难治性突发性聋患者预后相关因素分析
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摘要
目的:探讨糖皮质激素(GC)敏感性与难治性突发性聋(突聋)预后的关系,并分析影响难治性突聋预后的相关因素。方法:前瞻性对照观察91例难治性突聋患者,治疗前行外周单个核细胞体外增殖地塞米松(DEX)抑制实验,局部进行以甲泼尼龙为主的综合治疗,分析难治性突聋发病后3个月的疗效及影响预后的相关因素。结果:难治性突聋患者治疗总有效率为40.66%,性别、耳侧别、年龄、是否伴有眩晕或耳鸣、甲泼尼龙的局部使用方式与疗效无关,仅DEX抑制率、发病至就诊时间与疗效有关(R~2=0.712,0.118,均P<0.01),并且DEX抑制率与疗效相关性更强,GC有效组的DEX抑制率显著高于GC无效组。结论:DEX抑制率可用来反映难治性突聋患者的GC敏感性及预后,GC敏感性和发病至就诊时间是影响难治性突聋患者的2个重要因素,通过CCK-8法了解难治性突聋患者GC敏感性并尽早开始局部GC治疗,可改善预后。
Objective: To explore the relationships between glucocorticoid(GC) sensitivity and the prognosis of refractory sudden sensorineural hearing loss(SSNHL), and to analyze the related factors being affected the prognosis of SSNHL. Method: Ninety-one refractory SSNHL patients were enrolled in the present investigation. Peripheral blood mononuclear cells(PBMCs) from the refractory SSNHL were extracted to conduct GC proliferation dexamethasone(DEX) inhibition experiments. All patients accepted comprehensive treatment with methylprednisolone. Result: Total effective rate was 40.66% in refractory SSNHL patients. Gender, number of affected ear, age, accompanying with vertigo, tinnitus or not and the procedure of methylprednisolone treatment were irrelevant to the efficacy. Only the inhibitory rate of DEX and the time from onset to visit were related to GC treatment effect, especially for inhibitory rate of DEX. The DEX inhibition rate of the effective group was higher than that of the ineffective group.Conclusion: DEX inhibition rate can predict GC sensitivity and prognosis of SSNHL. GC sensitivity and the time from onset to treatment are two important factors affecting the prognosis of refractory SSNHL patients.
Objective: To explore the relationships between glucocorticoid(GC) sensitivity and the prognosis of refractory sudden sensorineural hearing loss(SSNHL), and to analyze the related factors being affected the prognosis of SSNHL. Method: Ninety-one refractory SSNHL patients were enrolled in the present investigation. Peripheral blood mononuclear cells(PBMCs) from the refractory SSNHL were extracted to conduct GC proliferation dexamethasone(DEX) inhibition experiments. All patients accepted comprehensive treatment with methylprednisolone. Result: Total effective rate was 40.66% in refractory SSNHL patients. Gender, number of affected ear, age, accompanying with vertigo, tinnitus or not and the procedure of methylprednisolone treatment were irrelevant to the efficacy. Only the inhibitory rate of DEX and the time from onset to visit were related to GC treatment effect, especially for inhibitory rate of DEX. The DEX inhibition rate of the effective group was higher than that of the ineffective group.Conclusion: DEX inhibition rate can predict GC sensitivity and prognosis of SSNHL. GC sensitivity and the time from onset to treatment are two important factors affecting the prognosis of refractory SSNHL patients.
引文
[1]STACHLER R J,CHANDRASEKHAR S S,ARCH-ER S M,et al.Clinical practice guideline:sudden hearing loss[J].Otolaryngol Head Neck Surg,2012,146(3Suppl):S1-35.
[2]周霓,李玲波.突发性聋预后相关因素的研究进展[J].临床耳鼻咽喉头颈外科杂志,2017,31(4):323-326.
[3]SHE W,DAI Y,DU X,et al.Hearing evaluation of intratympanic methylprednisolone perfusion for refractory sudden sensorineural hearing loss[J].Otolaryngol Head Neck Surg,2010,142:266-271.
[4]SUZUKI H,TABATA T,KOIZUMI H,et al.Prediction of hearing outcomes by multiple regression analysis in patients with idiopathic sudden sensorineural hearing loss[J].Ann Otol Rhinol Laryngol,2014,123:821-825.
[5]BARNES P J,ADCOCK I M.Glucocorticoid resistance in inflammatory diseases[J].Lancet,2009,373:1905-1917.
[6]DENDONCKER K,LIBERT C.Glucocorticoid resistance as a major drive in sepsis pathology[J].Cytokine Growth Factor Rev,2017,35:85-96.
[7]后婕,齐慧,戴艳红,等.激素抵抗对突发性聋治疗效果影响的临床观察[J].中华耳鼻咽喉头颈外科杂志,2017,52(8):566-572.
[8]杨晓琦,余力生,马鑫.耳后注射复方倍他米松治疗顽固性低频型感音神经性聋[J].中华耳鼻咽喉头颈外科杂志,2007,42(11):814-816.
[9]KARA E,CETIK F,TARKAN O,et al.Modified intratympanic treatment for idiopathic sudden sensorineural hearing loss[J].Eur Arch Otorhinolaryngol,2010,267:701-707.
[10]TRUNE D R,KEMPTON J B.Low dose combination steroids control autoimmune mouse hearing loss[J].JNeuroimmunol,2010,229:140-145.
[11]HOU J,SHE W,DU X,et al.Histone Deacetylase 2in Sudden Sensorineural Hearing Loss Patients in Response to Intratympanic Methylprednisolone Perfusion[J].Otolaryngol Head Neck Surg,2016,154:164-170.
[12]HO H G,LIN H C,SHU M T,et al.Effectiveness of intratympanic dexamethasone injection in suddendeafness patients as salvage treatment[J].Laryngoscope,2004,114:1184-1189.
[13]CHOUNG Y H,PARK K,SHIN Y R,et al.Intratympanic dexamethasone injection for refractory sudden sensorineural hearing loss[J].Laryngoscope,2006,116:747-752.
[14]MATTOX D E,SIMMONS F B.Natural history of sudden sensorineural hearing loss[J].Ann Otol Rhinol Laryngol,1977,86(4Pt 1):463-480.
[15]LEE H S,LEE Y J,KANG B S,et al.A clinical analysis of sudden sensorineural hearing loss cases[J].Korean J Audiol,2014,18:69-75.
[16]NAROZNY W,KUCZKOWSKI J,KOT J,et al.Prognostic factors in sudden sensorineural hearing loss:our experience and a review of the literature[J].Ann Otol Rhinol Laryngol,2006,115:553-558.
[17]BULˇGURCU S,爦AHIN B,AKGL G,et al.The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss[J].Int Arch Otorhinolaryngol,2018,22:33-37.
[18]HONG S M,KO Y G,PARK C H,et al.Analysis of hearing improvement in patients with severe to profound sudden sensorineural hearing loss according to the level of pure tone hearing threshold[J].Eur Arch Otorhinolaryngol,2012,269:2057-2060.
[19]BOGAZ E A,SUZUKI F A,ROSSINI B A,et al.Glucocorticoid influence on prognosis of idiopathic sudden sensorineural hearing loss[J].Braz J Otorhinolaryngol,2014,80:213-219.
[20]ALLES M J,DER GAAG M A,STOKROOS R J.Intratympanic steroid therapy for inner ear diseases,a review of the literature[J].Eur Arch Otorhinolaryngol,2006,263:791-797.
[21]朱晓月,王巍,陈鱼,等.102例突发性聋患者近期与远期疗效及预后的影响因素比较[J].临床耳鼻咽喉头颈外科杂志,2018,32(17):1325-1331.
[22]王军,肖水芳,曾镇罡,等.突聋预后相关因素分析[J].中华耳鼻咽喉头颈外科杂志,2015,50(6):448-452.
[23]NOSRATI-ZARENOE R,HANSSON M,HULT-CRANTZ E.Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome[J].Acta Otolaryngol,2010,130:384-391.
[24]LI J,YU L,XIA R,et al.Postauricular hypodermic injection to treat inner ear disorders:experimental feasibility study using magnetic resonance imaging and pharmacokinetic comparison[J].J Laryngol Otol,2013,127:239-245.
[2]周霓,李玲波.突发性聋预后相关因素的研究进展[J].临床耳鼻咽喉头颈外科杂志,2017,31(4):323-326.
[3]SHE W,DAI Y,DU X,et al.Hearing evaluation of intratympanic methylprednisolone perfusion for refractory sudden sensorineural hearing loss[J].Otolaryngol Head Neck Surg,2010,142:266-271.
[4]SUZUKI H,TABATA T,KOIZUMI H,et al.Prediction of hearing outcomes by multiple regression analysis in patients with idiopathic sudden sensorineural hearing loss[J].Ann Otol Rhinol Laryngol,2014,123:821-825.
[5]BARNES P J,ADCOCK I M.Glucocorticoid resistance in inflammatory diseases[J].Lancet,2009,373:1905-1917.
[6]DENDONCKER K,LIBERT C.Glucocorticoid resistance as a major drive in sepsis pathology[J].Cytokine Growth Factor Rev,2017,35:85-96.
[7]后婕,齐慧,戴艳红,等.激素抵抗对突发性聋治疗效果影响的临床观察[J].中华耳鼻咽喉头颈外科杂志,2017,52(8):566-572.
[8]杨晓琦,余力生,马鑫.耳后注射复方倍他米松治疗顽固性低频型感音神经性聋[J].中华耳鼻咽喉头颈外科杂志,2007,42(11):814-816.
[9]KARA E,CETIK F,TARKAN O,et al.Modified intratympanic treatment for idiopathic sudden sensorineural hearing loss[J].Eur Arch Otorhinolaryngol,2010,267:701-707.
[10]TRUNE D R,KEMPTON J B.Low dose combination steroids control autoimmune mouse hearing loss[J].JNeuroimmunol,2010,229:140-145.
[11]HOU J,SHE W,DU X,et al.Histone Deacetylase 2in Sudden Sensorineural Hearing Loss Patients in Response to Intratympanic Methylprednisolone Perfusion[J].Otolaryngol Head Neck Surg,2016,154:164-170.
[12]HO H G,LIN H C,SHU M T,et al.Effectiveness of intratympanic dexamethasone injection in suddendeafness patients as salvage treatment[J].Laryngoscope,2004,114:1184-1189.
[13]CHOUNG Y H,PARK K,SHIN Y R,et al.Intratympanic dexamethasone injection for refractory sudden sensorineural hearing loss[J].Laryngoscope,2006,116:747-752.
[14]MATTOX D E,SIMMONS F B.Natural history of sudden sensorineural hearing loss[J].Ann Otol Rhinol Laryngol,1977,86(4Pt 1):463-480.
[15]LEE H S,LEE Y J,KANG B S,et al.A clinical analysis of sudden sensorineural hearing loss cases[J].Korean J Audiol,2014,18:69-75.
[16]NAROZNY W,KUCZKOWSKI J,KOT J,et al.Prognostic factors in sudden sensorineural hearing loss:our experience and a review of the literature[J].Ann Otol Rhinol Laryngol,2006,115:553-558.
[17]BULˇGURCU S,爦AHIN B,AKGL G,et al.The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss[J].Int Arch Otorhinolaryngol,2018,22:33-37.
[18]HONG S M,KO Y G,PARK C H,et al.Analysis of hearing improvement in patients with severe to profound sudden sensorineural hearing loss according to the level of pure tone hearing threshold[J].Eur Arch Otorhinolaryngol,2012,269:2057-2060.
[19]BOGAZ E A,SUZUKI F A,ROSSINI B A,et al.Glucocorticoid influence on prognosis of idiopathic sudden sensorineural hearing loss[J].Braz J Otorhinolaryngol,2014,80:213-219.
[20]ALLES M J,DER GAAG M A,STOKROOS R J.Intratympanic steroid therapy for inner ear diseases,a review of the literature[J].Eur Arch Otorhinolaryngol,2006,263:791-797.
[21]朱晓月,王巍,陈鱼,等.102例突发性聋患者近期与远期疗效及预后的影响因素比较[J].临床耳鼻咽喉头颈外科杂志,2018,32(17):1325-1331.
[22]王军,肖水芳,曾镇罡,等.突聋预后相关因素分析[J].中华耳鼻咽喉头颈外科杂志,2015,50(6):448-452.
[23]NOSRATI-ZARENOE R,HANSSON M,HULT-CRANTZ E.Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome[J].Acta Otolaryngol,2010,130:384-391.
[24]LI J,YU L,XIA R,et al.Postauricular hypodermic injection to treat inner ear disorders:experimental feasibility study using magnetic resonance imaging and pharmacokinetic comparison[J].J Laryngol Otol,2013,127:239-245.