Clinical characteristics and prognosis of sudden sensorineural hearing loss with rheumatoid arthritis
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摘要: 目的 探讨突发性聋(突聋)合并类风湿性关节炎(RA)患者的临床特征及疗效, 并分析RA病程对突聋听力预后的影响。方法 收集43例(46耳)合并RA的突聋患者(RA组)的临床资料, 并选择同时期住院治疗的386例(400耳)未合并RA的突聋患者(非RA组)作为对照组, 比较两组的临床特征及预后; 同时根据RA病程长短将RA组患者分为 < 5年组、5~10年组和>10年组, 比较3组突聋患者的听力预后。结果 在RA组中, 患者的突聋耳和非突聋耳初诊平均听阈值(PTA)分别为(64.53±12.77) dB HL和(31.28±8.53) dB HL, 均高于非RA组中的(54.31±13.45) dB HL和(24.83±6.06) dB HL, 差异有统计学意义(P < 0.05)。经治疗后, RA组中突聋耳和非突聋耳治疗后PTA均为(48.26±13.49) dB HL和(27.93±10.22) dB HL, 均高于非RA组中的(33.65±9.22) dB HL和(21.86±6.88) dB HL, 差异有统计学意义(P < 0.05);RA组中突聋耳听阈改善值为(16.27±6.01) dB HL, 总有效率为52.17%, 均低于非RA组的(20.66±6.21) dB HL和75.00%(P=0.010), 而两组间非突聋耳听阈改善值差异无统计学意义(P>0.05)。 < 5年组、5~10年组和>10年组的痊愈率、显效率、有效率和无效率差异无统计学意义, 但3组患者的耳听阈改善值分别为(20.77±8.63) dB HL、(17.00±6.81) dB HL和(11.94±5.73) dB HL, 组间比较差异有统计学意义(P=0.011)。结论 合并RA的突聋患者听力损伤较重, 听力预后较差, 且随着RA病程的延长预后越差。Abstract: Objective To analyze the clinical features and prognosis of sudden sensorineural hearing loss(SSNHL) with rheumatoid arthritis(RA), and evaluate the effect of the course of RA on the hearing recovery.Methods We collected the clinical data of 43 SSNHL patients(46 ears) with RA(RA group) who were hospitalized in our hospital, and compared their clinical characteristics and prognosis with 386 SSNHL patients(400 ears) without RA(non-RA group). 43 SSNHL patients with RA were further grouped into < 5 years group, 5-10 years group and >10 years group, and the hearing recovery was compared among three groups.Results In the RA group, the initial pure tone average(PTA) of SSNHL and non-SSNHL ears were (64.53±12.77) dB HL and (31.28±8.53) dB HL, which were higher than those in the non-RA group(54.31±13.45) dB HL and(24.83±6.06) dB HL(P < 0.05). After treatment, in the RA group, posttreatment PTA of SSNHL and non-SSNHL ears were (48.26±13.49) dB HL and (27.93±10.22) dB HL, which were higher than those in the non-RA group (33.65±9.22) dB HL and (21.86±6.88) dB HL(P < 0.05), and the hearing gains of SSNHL ear and the rate of overall recovery were (16.27±6.01) dB HL and 52.17%, which were lower than those in the non-RA group (20.66±6.21) dB HL and 75.00%. No statistic difference was observed in the hearing gains of non-SSNHL ear between the two groups(P>0.05). The hearing gains in the < 5 years group, 5-10 years group and >10 years group were (20.77±8.63) dB HL, (17.00±6.81) dB HL and (11.94±5.73) dB HL, statistic differences were observed among the three groups(P=0.010), but no statistic difference was observed in the rate of complete recovery, marked recovery, recovery and no recovery(P>0.05).Conclusion SSNHL patients with RA often suffers a severe hearing loss, and the hearing recovery is poor. The longer the course of RA, the worse the prognosis.
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Key words:
- rheumatoid arthritis /
- hearing loss, sudden /
- clinical characteristics /
- prognosis
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表 1 两组患者的临床资料对比
指标 RA组 非RA组 χ2/t P 男/女 23/20 201/185 0.031 0.874 年龄/岁 45.84±11.67 47.14±10.51 -0.761 0.447 左耳/右耳 25/21 190/210 0.775 0.437 双耳 3(7.00) 14(3.62) 1.141 0.237 突聋耳初诊PTA/dB HL 64.53±12.77 54.31±13.45 4.905 < 0.001 非突聋耳初诊PTA/dB HL 31.28±8.53 24.83±6.06 6.520 < 0.001 突聋病程/d 8.07±5.93 7.50±4.74 0.728 0.467 耳鸣 30(65.22) 246(61.50) 0.242 0.749 眩晕 15(32.61) 93(23.25) 1.969 0.202 高血压 8(18.60) 50(12.95) 1.057 0.344 糖尿病 7(16.30) 31(8.03) 3.260 0.086 听力曲线类型 2.617 0.454 低频下降型 6(13.95) 83(20.75) 高频下降型 9(19.57) 92(23.00) 平坦下降型 13(28.26) 105(26.25) 全聋型 18(39.13) 120(30.00) 
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表 2 两组患者听力预后指标比较
指标 RA组(46耳) 非RA组(400耳) χ2/(t) P 疗效 痊愈 4(8.70) 73(18.25) 2.637 0.147 显效 8(17.39) 107(26.75) 1.888 0.213 有效 12(26.09) 120(30.00) 0.303 0.733 无效 22(47.83) 100(25.00) 10.817 0.003 突聋耳 治疗后PTA/dB HL 48.26±13.49 33.65±9.22 9.636 < 0.001 听阈改善值/dB HL 16.27±6.01 20.66±6.21 -4.555 < 0.001 非突聋耳 治疗后PTA/dB HL 27.93±10.22 21.86±6.88 5.349 < 0.001 听阈改善值/dB HL 3.35±2.86 2.97±2.27 1.045 0.297
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表 3 突聋伴不同病程RA患者的临床资料和疗效指标对比
指标 < 5年组(12例，13耳) 5~10年组(15例，15耳) >10年组(16例，18耳) χ2(F) P 男/女 6/6 8/7 9/7 0.108 0.947 年龄/岁 42.75±11.67 45.33±11.67 46.19±11.67 0.311 0.734 左耳/右耳 7/6 8/7 10/8 0.018 0.991 双耳 1(8.33) 0(0.00) 2(12.50) 1.696 0.428 突聋耳初诊PTA/dB HL 63.46±14.20 64.00±17.84 65.27±19.89 0.043 0.958 非突聋耳初诊PTA/dB HL 32.31±11.27 30.33±14.71 31.67±13.67 0.081 0.922 突聋病程/d 9.08±5.85 8.27±6.21 7.19±5.87 0.352 0.706 耳鸣 8(61.54) 9(60.00) 13(72.22) 0.647 0.724 眩晕 5(38.46) 4(26.67) 6(33.33) 0.448 0.799 高血压 2(16.67) 2(13.33) 4(25.00) 0.737 0.692 糖尿病 2(16.67) 2(13.33) 3(18.75) 0.169 0.919 听力曲线类型 低频下降型 3(23.08) 2(13.33) 1(5.56) 3.959 0.682 高频下降型 3(23.08) 3(20.00) 4(22.22) 平坦下降型 4(30.77) 5(33.33) 5(27.78) 全聋型 3(23.08) 5(33.33) 10(55.56) 疗效 痊愈 2(15.38) 2(13.33) 0(0.00) 2.853 0.240 显效 5(38.46) 1(6.67) 2(11.11) 5.712 0.057 有效 3(23.08) 5(33.33) 4(22.22) 0.609 0.737 无效 3(23.08) 7(46.67) 12(66.67) 5.760 0.056 听阈改善值/dB HL 20.77±8.63 17.00±6.81 11.94±5.73 5.102 0.010
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