Analysis of coagulation state in sudden deafness patients with total deafness and vertigo
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摘要: 目的 通过分析全聋伴眩晕的突发性聋(简称突聋)患者凝血功能状态及预后，为改进治疗方案，从而改善预后提供依据。方法 选取2017年1月—2020年12月于河北省人民医院耳鼻咽喉头颈外科住院治疗的全聋伴眩晕的突聋患者33例作为研究组；同期住院治疗的低频型、全频型、全聋型患者各33例以及高频型患者26例作为突聋对照组，无中耳及内耳疾病史的住院患者33例为正常对照组。分析研究组与各对照组间纤维蛋白原(FIB)、D-二聚体(D-D)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)水平及不同类型突聋患者的疗效。结果 ① 研究组FIB、D-D分别为2.50(2.11，2.95)、0.27(0.16，0.51)，均高于正常组[2.31(1.92，2.50)、0.17(0.12，0.21)]；APTT为25.2(23.1，28.1)，低于正常组[27.3(26.4，29.7)]，差异均有统计学意义(P＜0.01)。②研究组FIB高于低频组[2.37(1.81，2.68)]；D-D分别高于低频组[0.16(0.12，0.25)]、高频组[0.13(0.11，0.23)]、全频组[0.16(0.11，0.28)]、全聋组[0.18(1.45，0.30)]；APTT为25.75±3.18/25.2(23.1，28.1)，低于低频组(27.72±2.22)、全频组[26.7(25.8，28.7)]，差异均有统计学意义(P＜0.05)。③研究组疗效最差(无效率为63.6%)，低频组疗效最好(痊愈率为75.8%)，各型突聋组间疗效差异有统计学意义(P＜0.05)。结论 高凝状态、血栓形成可能是全聋型突聋患者的发病影响因素之一。全聋伴眩晕的突聋患者比全聋型及其他各型突聋的高凝状态更严重，预后最差。Abstract: Objective To analyze the coagulation status and prognosis of sudden deafness patients with total deafness accompanied by vertigo, and to provide basis for improving the treatment of this disease.Methods From January 2017 to December 2020, 33 patients with total deafness and vertigo sudden deafness who were hospitalized in the Department of Otolaryngology Head and Neck Surgery, Hebei Provincial People's Hospital were selected as the research group. During the same period, 33 cases of low frequency type, full frequency type, total deafness and 26 cases of high frequency type were treated as control group.Thirty-three cases of inpatients without history of middle ear and inner ear diseases were treated as normal control group. The levels of fibrinogen(FIB), D-Dimer(D-D), Prothrombin Time(PT), Activated Partial Thrombin Time(APTT) between the research group and the control group were analyzed, and the therapeutic effects of different types of sudden deafness patients were analyzed.Results FIB and D-D of total deafness with vertigo were 2.50(2.11, 2.95)and 0.27(0.16, 0.51) respectively, which were higher than 2.31(1.92, 2.50) and 0.17(0.12, 0.21) of normal group. APTT was 25.2(23.1, 28.1), lower than 27.3(26.4, 29.7) in the normal group, the differences were statistically significant(P < 0.01). ② FIB of total deafness with vertigo was 2.50(2.11, 2.95), which was higher than that of low frequency group 2.37(1.81, 2.68). D-D was 0.27(0.16, 0.51), higher than low frequency group 0.16(0.12, 0.25), high frequency group of 0.13(0.11, 0.23), the whole frequency group 0.16(0.11, 0.28), total of 0.18(1.45, 0.30). APTT was 25.75±3.18/25.2(23.1, 28.1), lower than 27.72±2.22 in low frequency group and 26.7(25.8, 28.7) in full frequency group, with statistical significance(P < 0.05). ③ The total deafness with vertigo group had the worst curative effect(ineffective rate was 63.6%), and the low frequency group had the best curative effect(recovery rate was 75.8%). The difference of curative effect among different types of sudden deafness groups was statistically significant(P < 0.05).Conclusion Hypercoagulability and thrombosis may be one of the influencing factors of total sudden deafness. The hypercoagulable state of sudden deafness patients with total deafness and vertigo is more serious than that of total deafness and other types of sudden deafness, and the prognosis is the worst.
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Key words:
- deafness, sudden /
- vertigo /
- coagulation state
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表 1 研究组与对照组的一般资料比较
项目 研究组 对照组 低频组 高频组 全频组 全聋组 正常组 性别 男 18 15 15 15 12 18 女 15 18 11 18 21 15 年龄/岁 59(48，63)1)2) 35(30，53) 39(31，54) 50(40，56) 56(44，63) 51(43，59) 与低频组比较，1)P＜0.05；与高频组比较，2)P＜0.05。 
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表 2 研究组与正常组的凝血参数比较
M(P25，P75) 组别 FIB/(g·L-1) D-D/(mg·L-1) PT/s APTT/s 研究组 2.50(2.11，2.95) 0.27(0.16，0.51) 10.7(10.3，11.3) 25.2(23.1，28.1) 正常组 2.31(1.92，2.50) 0.17(0.12，0.21) 11.1(10.5，11.5) 27.3(26.4，29.7) U 340.00 279.00 432.50 306.50 P 0.009 0.001 0.150 0.002
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表 3 研究组与各突聋对照组的凝血参数比较
组别 FIB/(g·L-1) D-D/(mg·L-1) PT/s APTT/s 研究组 2.50(2.11，2.95)1) 0.27(0.16，0.51)1)2)3)4) 10.7(10.3，11.3) 25.75±3.18a)1)/25.2(23.1，28.1)b)3) 对照组 低频组 2.37(1.81，2.68) 0.16(0.12，0.25) 10.8(10.6，11.3) 27.72±2.22 高频组 2.40(1.95，2.77) 0.13(0.11，0.23) 10.5(10.1，10.8) 27.15±2.97 全频组 2.56(2.25，2.89) 0.16(0.11，0.28) 10.8(10.4，11.0) 26.7(25.8，28.7) 全聋组 2.63(2.07，2.78) 0.18(1.45，0.30) 11.0(10.4，11.5) 26.38±3.19 注：a)数据满足正态分布及方差齐时所用数值；b)不满足正态分布或方差不齐时所用数值。
与低频组比较，1)P＜0.05；与高频组比较，2)P＜0.05；与全频组比较，3)P＜0.05；与全聋组比较，4)P＜0.05。
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表 4 不同类型突聋患者的疗效比较
例(%) 组别 例数 预后 Z值 P值 无效 有效 显效 痊愈 研究组 33 21(63.6) 5(15.2) 6(18.2) 1(3.0) 对照组 低频组 33 3(9.1) 2(6.1) 3(9.1) 25(75.8) 41.010 0.001 高频组 26 12(46.2) 7(26.9) 0(0) 7(26.9) 全频组 33 9(27.3) 5(15.2) 6(18.2) 13(39.4) 全聋组 33 11(33.3) 5(15.2) 10(30.3) 7(21.2)
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