Association of sudden sensorineural hearing loss and its prognosis with the brain white matter hyperintensity
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摘要: 目的 探讨脑白质高信号(WMH)与突发性聋(简称突聋)的关系及对突聋预后的影响。方法 纳入2019年6月—2020年6月期间以单侧突聋住院的患者50例(突聋组)和年龄、性别匹配无突聋病史的常规体检者50例(对照组)进行病例对照研究。所有纳入对象完善3.0T头颅磁共振检查，采用Fazekas量表对脑室周围白质高信号(PVWMH)和深部白质高信号(DWMH)进行独立评分，比较突聋组与对照组Fazekas评分和Fazekas评分频率分布情况，采用有序logistic回归研究突聋患者预后与WMH的关系。结果 突聋患者WMH的Fazekas评分明显高于对照组(PVWMH：P=0.004，DWMH：P=0.010);突聋组与对照组Fazekas评分频率分布差异有统计学意义(PVWMH：P=0.036，DWMH：P=0.047);有序logistic回归结果显示突聋患者不合并WMH即Fazekas=0是突聋预后良好的独立预测因素(P=0.025，OR=12.779)。结论 突聋患者合并脑白质高信号较无突聋者更常见，不合并脑白质高信号较合并脑白质高信号的突聋患者预后更好。Abstract: Objective To explore the relationship between white matter hyperintensity(WMH) and sudden sensorineural hearing loss(SSHL) and evaluate the influence of WMH on the prognosis of SSHL.Methods Fifty hospitalized unilateral SSHL patients and 50 age and gender matched routine physical examination individuals without SSHL history from June 2019 to June 2020 were included for a case-control study. All included subjects underwent 3.0 Tesla cranial magnetic resonance examination, and the Fazekas scale was applied to evaluate periventricular white matter hyperintense(PVWMH) and deep white matter hyperintense(DWMH). Fazekas score and distribution proportions of Fazekas score was compared between SSHL and control. Ordered logistic regression was used to study the relationship between prognosis of SSHL and WMH.Results The Fazekas score of WMH in SSHL group was significantly higher than that of control group(PVWMH: P=0.004, DWMH: P=0.010); There was a significant difference in the distribution proportions of Fazekas scores between SSHL and control(PVWMH: P=0.036, DWMH: P=0.047); The results of ordered logistic regression showed that patients without WMH(Fazekas=0) is an independent predictor of good prognosis in SSHL(P=0.025, OR=12.779).Conclusion The prevalence of WMH in SSHL patients was higher than that of control. SSHL patients without WMH has a better prognosis than those with WMH.
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表 1 脑白质病变Fazekas评分
病变部位 0分 1分 2分 3分 PVWMH 脑室旁无病灶 帽状或者铅笔样薄层病变 光滑的光晕病变 病变延伸到深部白质 DWMH 脑深部无病变 点状高信号 开始融合的点状病灶 大面积融合的病灶 
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表 2 突聋组与对照组基线资料及WMH比较
项目 突聋组(n=50) 对照组(n=50) t/Z/χ2 P值 年龄/岁 56.68±12.03 55.94±14.69 0.275 0.784 性别/例(%) 男性 24(48.0) 26(52.0) 0.360 0.548 女性 26(52.0) 24(48.0) 高血压/例(%) 19(38.0) 21(42.0) 0.167 0.683 糖尿病/例(%) 9(18.0) 10(20.0) 0.065 0.799 甘油三酯/(mmol·L-1) 1.44±0.61 1.57±0.82 -0.966 0.336 胆固醇/(mmol·L-1) 3.91±0.93 3.94±1.00 -1.560 0.876 低密度脂蛋白/(mmol·L-1) 2.85±1.23 3.03±1.01 -0.931 0.354 脑白质病变 PVWMH 1.02±0.14
1.0(0，3.0)0.50±0.10
0(0，2.0)-2.872 0.004 DWMH 0.94±0.13
1.0(0，3.0)0.48±0.10
0(0，2.0)-2.567 0.010
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表 3 突聋组患者临床特征及变量赋值
变量 例数(%) 变量及赋值 变量 例数(%) 变量及赋值 年龄/岁 56.68±12.03 X1 发病至治疗时间/d X6 ＜60 15(30) 1 1~3 11(22) 60~80 25(50) 2 4~14 23(46) ＞80 10(20) 3 ＞14 16(32) 性别 X2 听阈曲线类型 X7 男 24(48) 1 低频下降型 12(24) 女 26(52) 2 高频下降型 14(28) 合并眩晕 13(26) X3，1=眩晕，2=不眩晕 平坦下降型 13(26) 合并耳鸣 15(30) X4，1=耳鸣，2=不耳鸣 全聋型 11(22) 发病时听力损失程度 X5 脑血管危险因素 轻度 19(38) 1 高血压 19(38) X8，1=高血压，2=正常 中度 10(20) 2 糖尿病 9(18) X9，1=糖尿病，2=正常 重度 12(24) 3 高脂血症 20(40) X10，1=高脂血症，2=正常 极重度 9(18) 4 脑白质病变 X11 听力恢复情况 Y Fazekas=0 18(36) 1 无效 22(44) 1 Fazekas≥1 32(64) 2 有效 9(18) 2 显效 11(22) 3 痊愈 8(16) 4
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表 4 突聋组患者预后有序Logistic回归分析结果
影响因素 回归系数 标准误 Wald χ2 P值 OR(95%CI) 年龄/岁 ＜60 2.047 1.106 4.313 0.036 7.744(1.986~36.479) 60~80 1.353 0.812 1.237 0.401 3.869(1.684~22.463) ＞80(Ref) - - - - - 性别 男 -1.654 0.565 1.146 0.384 0.191(-1.174~4.363) 女(Ref) - - - - - 合并疾病 眩晕，X3=1 -3.909 1.013 4.144 0.042 0.020(-4.864~0.840) 耳鸣，X4=1 -0.596 0.457 0.167 0.682 0.551(-1.899~3.445) 发病听力损失程度 轻度 3.629 1.493 4.954 0.028 37.675(7.896~82.774) 中度 1.534 1.197 0.262 0.609 4.636(2.771~29.858) 重度 -0.901 0.961 0.273 0.601 0.406(-2.327~24.633) 极重度(Ref) - - - - - 发病至治疗时间/d 1~3 3.622 1.236 4.095 0.047 37.412(14.896~62.747) 4~14 1.501 1.285 0.238 0.505 4.486(2.882~32.737) ＞14(Ref) - - - - - 听阈曲线类型 低频下降型 3.258 1.136 8.693 0.003 26.708(7.896~82.774) 平坦下降型 2.886 1.196 5.658 0.017 17.921(4.896~52.101) 高频下降型 1.210 0.904 2.376 0.123 3.353(1.896~24.149) 全聋型(Ref) - - - - - 重度(Ref) - - - - - 高血压，X6=1 -0.755 0.735 3.075 0.080 0.947(0.224~3.996) 糖尿病，X7=1 -0.996 1.138 0.742 0.389 0.927(0.107~8.060) 高脂血症，X8=1 -0.930 0.701 1.287 0.257 0.379(0.070~2.050) WMH Fazekas=0 2.345 0.939 5.021 0.025 12.779(2.244~21.934) Fazekas≥1(Ref) - - - - -
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