Key factors of the severity of chronic subjective tinnitus: a complex network analysis
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摘要: 目的 通过复杂网络分析探讨影响慢性主观性耳鸣严重程度的关键因素。 方法 回顾性分析2019年12月—2020年10月就诊于北京协和医院耳鼻咽喉头颈外科的慢性主观性耳鸣患者的临床资料, 包括人口学特征、听力学特点及耳鸣相关检查结果, 以患者就诊时填写的中文版耳鸣残障量表(THI)、医院焦虑抑郁量表、匹兹堡睡眠质量指数、耳鸣响度和烦恼程度视觉模拟评分量表得分评估其睡眠及心理声学特征。将以上相关信息作为节点, 利用R语言构建复杂网络模型, 分析以上节点与患者THI得分的相关性。 结果 共183例患者符合入组条件, 其中男99例(54.1%), 女84例(45.9%), 年龄(41.65±1.05)岁。复杂网络分析结果提示THI得分与焦虑、睡眠障碍密切相关, 焦虑较睡眠障碍与THI得分的关系更紧密; 患者自觉耳鸣相关性焦虑与耳鸣相关性睡眠障碍之间有较强的相关性。人口学特征、听力学及耳鸣相关检查与THI得分无明显相关性。 结论 耳鸣严重程度与焦虑和睡眠障碍密切相关, 情绪与睡眠是调控耳鸣的关键因素, 且焦虑的作用更大。睡眠障碍与焦虑存在一定的相关性, 二者可能在调控耳鸣的作用中产生叠加效应, 进一步加重耳鸣的严重程度。未来对于慢性主观性耳鸣的治疗, 应更加关注改善焦虑及睡眠状况以提高疗效。Abstract: Objective To investigate the key factors related to the severity of chronic subjective tinnitus through a complex network analysis. Methods A retrospective study about patients with chronic subjective tinnitus presented to Peking Union Medical College Hospital from December 2019 to October 2020 was conducted. The demographic information, audiometric and tinnitus-related tests, and scores of Tinnitus Handicap Inventory(THI), Hospital Anxiety and Depression Scale(HADS), Pittsburgh Sleep Quality Index(PSQI) and Visual Analogue Scale(VAS) of tinnitus loudness and annoyance were set as nodes in a complex network which was conducted and analyzed through the R package. Results A total of 183 patients were enrolled, including 99(54.1%) males and 84(45.9%) females, with an average age of(41.65±1.05) years. The results of the complex network analysis showed that anxiety and sleep disorder were closely related to THI score, and anxiety was more important than sleep disorder. There was a strong correlation between self-reported anxiety and insomnia. Demographic characteristics, audiologic and tinnitus-associated tests were not significantly related to THI score. Conclusion Anxiety and sleep disturbance were key factors related to tinnitus severity, and anxiety played a more important role. There was an obvious correlation between sleep disorder and anxiety, and they might have a superimposed effect on tinnitus severity. Future therapies of tinnitus should pay more attention on releasing anxiety and insomnia.
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Key words:
- tinnitus /
- anxiety /
- sleep /
- complex network analysis
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表 1 人口学特征
例(%) 人口学特征 例(%) 人口学特征 例(%) BMI 自觉耳鸣相关性听力下降 ≤24 76(41.5) 否 95(51.9) >24 107(58.5) 是 88(48.1) 耳鸣病程/年 自觉耳鸣相关性焦虑 ≤4 136(74.3) 否 65(35.5) >4 47(25.7) 是 118(64.5) 耳鸣侧别 自觉耳鸣相关性睡眠障碍 左 41(22.4) 否 88(48.1) 右 46(25.1) 是 95(51.9) 双侧 96(52.5) 环境噪声中耳鸣是否缓解 伴随疾病 无变化 96(52.4) 否 139(76.0) 缓解 45(24.6) 是 44(24.0) 加重 42(23.0) 耳相关性疾病 按摩耳周或活动下颌、颈部耳鸣是否缓解 否 156(85.2) 无变化 137(74.8) 是 27(14.8) 缓解 40(21.9) 加重 6(3.3) 
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表 2 听力检查、耳鸣相关检查、心理声学和睡眠特征
变量 值(n=183) 变量 值(n=183) 听力曲线分型/例(%) HADS 正常 64(35.0) HADS-焦虑/分 7.89±0.22 缓降型 2(1.0) 正常/例(%) 87(47.5) 陡降型 42(23.0) 异常/例(%) 96(52.5) 高频下降型 59(32.2) HADS-抑郁/分 9.50±0.16 上升型 12(6.6) 正常/例(%) 19(10.4) 切迹型 4(2.2) 异常/例(%) 164(89.6) 言语频率平均听阈/dB HL 19.98±1.01 PSQI总分/分 6.84±0.32 耳鸣响度/dB SL 10.50±0.99 正常/例(%) 57(36.6) 最小掩蔽级/dB SL 12.29±1.36 异常/例(%) 116(63.4) 耳鸣频率/例(%) 睡眠质量/分 0.62±0.04 ≤0.5 kHz 20(10.9) 睡眠潜伏期/分 1.52±0.08 1~3 kHz 31(16.9) 睡眠时间/分 0.96±0.08 ≥4 kHz 132(72.2) 睡眠效率/分 1.15±0.10 残余抑制试验/例(%) 睡眠障碍/分 0.87±0.05 无变化或反跳 72(39.3) 睡眠药物使用/分 0.29±0.07 完全或部分缓解 111(60.7) 日间功能障碍/分 0.83±0.06 THI总分/分 41.15±2.21 耳鸣响度VAS/分 4.68±0.19 功能性子量表得分 18.06±1.01 耳鸣烦恼程度VAS/分 4.81±0.21 灾难性子量表得分 9.35±0.48 情感子量表得分 13.73±0.89
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