Multifactorial analysis of the degree of hearing loss and outcome in patients with sudden hearing loss
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摘要: 目的探讨突发性聋(SHL)听力损失严重程度及疗效与临床指标的关系。方法选取273例SHL患者，按照入院时首次纯音测听受累耳累及频率的平均听阈行三分位数分组，单因素、多因素有序logistic回归评估SHL患者初始听力水平与临床指标的关系，Spearman相关系数分析SHL疗效与临床指标的相关性。结果与较低听力损失(≤50 dB HL)患者相比，较高听力损失(>50 dB HL)患者伴有较高的中性粒细胞、单核细胞、甘油三酯、血红蛋白、纤维蛋白原、葡萄糖、中性粒细胞/高密度脂蛋白(NHR)、单核细胞/高密度脂蛋白、单核细胞/淋巴细胞、年龄、眩晕以及较低的血小板/淋巴细胞、高密度脂蛋白和较差的最终听阈(均P < 0.05)。多因素有序logistic回归分析显示NHR、年龄是SHL患者初始听力损失的独立危险因素。NHR、中性粒细胞/淋巴细胞(NLR)、病程、听力曲线类型、最终听阈与疗效呈显著负相关。结论NHR和NLR值越高、从发病到就诊时间越长、听力损失程度越严重的SHL患者疗效越差，而NHR、年龄值越高SHL患者初始听力损失越严重，不同类型听阈曲线及年龄的SHL患者听力损失程度及疗效不同。Abstract: ObjectiveTo investigate the relationship between the severity and curative effect of hearing loss and clinical indicators in patients with sudden hearing loss (SHL).MethodsThe Spearman correlation coefficient was used to analyze the correlation between the efficacy of SHL and clinical indicators.A total of two hundred and seventy-three patients with SHL were selected and divided into three quantile groups according to the average hearing threshold of the the involved ear frequency of the first pure tone audiometry at admission. Univariate and multivariate ordered logistic regression were used to evaluate the relationship between initial hearing level and clinical indicators of SHL patients. The Spearman correlation coefficient was used to analyze the correlation between efficacy of SHL and clinical indicators.ResultsCompared with patients with lower hearing loss (≤50 dB HL), patients with higher hearing loss (>50 dB HL) had higher Neutrophil, Monocyte, Triglycerides, Hemoglobin, Fibrinogen, Glucose, Neutrophil/high-density lipoprotein cholesterol ratio (NHR), Monocyte/high-density lipoprotein cholesterol ratio, Monocyte/lymphocyte cell ratio, age, dizziness, and lower Platelet/ lymphocyte cell ratio and High-density lipoprotein cholesterol, and poor final hearing threshold.Multivariate logistic regression showed that NHR and age were independent risk factors for initial hearing loss in SHL patients.And the NHR, Neutrophil/lymphocyte cell ratio (NLR), course of disease, type of hearing curve, and final hearing threshold were significantly negatively correlated with curative effect.ConclusionSHL patients with higher NHR and NLR values, the longer time from onset to visit, and the more severe hearing loss had worse efficacy.However, SHL patients with higher NHR and age values had greater initial hearing loss, the degree of hearing loss and curative effect are different in SHL patients with different types of hearing threshold curve and age.
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Key words:
- deafness, sudden /
- hearing loss /
- treatment effectiveness
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表 1 不同初始听阈损失的SHL患者的基线特征
特征 初始听阈每三分位数/dB HL F/χ2/H P值 Q1≤50(n=98) Q2>50~80(n=92) Q3>80(n=83) 人口学特征 年龄/岁 39.95±11.63 44.80±13.271) 47.34±12.471) 8.33 < 0.001 女/例(%) 61(62.24) 47(51.09) 35(42.17)1) 7.36 0.025 男/例(%) 37(37.76) 45(48.91) 48(57.83)1) 听力曲线类型 305.24 < 0.001 低频下降型/例(%) 63(64.29) 5(5.43)1) 0(0)1) 高频下降型/例(%) 12(12.24) 19(20.65) 2(2.41)1)2) 平坦下降型/例(%) 22(22.45) 59(64.13)1) 3(3.61)1)2) 全聋型/例(%) 1(1.02) 9(9.78)1) 78(93.98)1)2) 病史 耳鸣/例(%) 73(74.49) 62(67.39) 52(62.65) 3.00 0.223 无耳鸣/例(%) 25(25.51) 30(32.61) 31(37.35) 眩晕/例(%) 4(4.08) 12(13.04) 16(19.28)1) 10.26 0.006 无眩晕/例(%) 94(95.92) 80(86.96) 67(80.72)1) 最终听阈/dB HL 20(15，30) 48(35，60)1) 80(65，90)1)2) 169.11 < 0.001 病程/d 5(3，10) 6(3，13.50) 6(3，11) 0.65 0.723 左耳/耳(%) 54(55.10) 53(57.61) 34(40.96) 5.88 0.053 右耳/耳(%) 44(44.90) 39(42.39) 49(59.04) 治疗效果 59.43 < 0.001 痊愈/例(%) 31(31.63) 36(39.13)1) 31(37.35)1) 显效/例(%) 31(31.63) 6(6.52)1) 0(0.00)1) 有效/例(%) 2(2.04) 20(21.74) 23(27.71) 无效/例(%) 34(34.69) 30(32.61) 29(34.94) 血清胆红素 IBIL/(μmol·L-1) 8.88(6.40，11.37) 8.13(5.27，11.08) 8.29(5.62，11.34) 2.13 0.344 TBIL/(μmol·L-1) 13.16(10.84，15.99) 13.12(11.26，16.09) 13.11(10.41，16.02) 0.07 0.964 DBIL/(μmol·L-1) 0.3(0.30，0.30) 0.3(0.30，0.30) 0.3(0.30，0.30) 2.62 0.269 血脂参数 TC/(mol·L-1) 4.66±0.93 4.60±1.11 4.63±0.97 0.10 0.905 TG/(mol·L-1) 1.09(0.71，1.65) 1.54(0.91，2.58) 1.72(1.07，3.01)1) 20.70 < 0.001 LDL-C/(mol·L-1) 2.57(2.14，3.32) 2.59(1.96，3.25) 2.46(2.08，3.17) 0.99 0.611 HDL-C/(mol·L-1) 1.31(1.09，1.57) 1.15(0.95，1.41)1) 1.08(0.93，1.36)1) 15.16 0.001 LDL-C/HDL-C 2.04(1.45，88) 2.33(1.45，3.10) 2.24(1.75，3.08) 2.25 0.324 其他血液学参数 NEUT(×109·L-1) 4.07(3.15，5.97) 4.39(3.38，5.82) 5.07(3.91，6.58)1) 8.61 0.014 LYM(×109·L-1) 1.74(1.24，2.29) 1.83(1.47，2.28) 1.97(1.40，2.29) 1.75 0.417 RBC(×109·L-1) 4.65±0.46 4.70±0.57 4.82±0.55 2.46 0.087 MONO(×109·L-1) 0.41(0.30，0.51) 0.45(0.33，0.57) 0.49(0.37，0.66)1) 11.08 0.004 RDW/ % 12.55(12.10，13.10) 12.40(12，12.90) 12.60(12.10，3.20) 1.36 0.507 Hb/(g·L-1) 138.67±20.07 142.03±19.03 147.02±16.371) 4.52 0.012 EOS(×109·L-1) 0.06(0.01，0.13) 0.07(0.02，0.15) 0.06(0.02，0.15) 0.81 0.666 FIB/(g·L-1) 2.67±0.62 2.88±0.641) 2.96±0.751) 4.83 0.009 PLT(×109·L-1) 255(216.50，302) 256.50(223.25，295.50) 244(198，293) 4.78 0.092 G/(mmol·L-1) 5.68(4.97，6.57) 6.25(5.39，8.07)1) 6.51(4.95，7.75) 8.57 0.014 NLR 2.14(1.67，3.94) 2.25(1.60，3.27) 2.69(1.94，3.64) 3.37 0.186 MLR 0.22(0.16，0.27) 0.23(0.18，0.30) 0.24(0.20，0.33)1) 7.71 0.021 PLR 148.65(113.88，204.04) 134.80(107.94，181.26) 120.30(102.40，163.82) 6.80 0.033 MHR 0.30(0.20，0.41) 0.35(0.25，0.54) 0.45(0.28，0.73)1) 18.62 < 0.001 NHR 3.32(2.33，4.77) 3.55(2.73，5.53) 5.03(3.17，7.05)1)2) 17.78 < 0.001 与Q1≤50比较，1)P < 0.05; 与Q2＞50~80比较，2)P < 0.05。 
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表 2 SHL患者初始听阈水平的单因素有序logistic回归分析
特征 β SE Wald χ2 OR 95%CI P值 年龄 0.035 0.089 14.944 1.035 1.017，1.053 < 0.001 男性 0.610 0.225 7.315 1.840 1.183，2.862 0.007 右耳 0.434 0.224 3.746 1.544 0.994，2.397 0.053 耳鸣 -0.413 0.240 2.958 0.662 0.413，1.059 0.085 眩晕 0.448 0.236 3.617 1.566 0.986，2.486 0.057 病程 0.001 0.012 0.007 1.001 0.978，1.025 0.935 IBIL -0.011 0.022 0.225 0.990 0.948，1.033 0.635 TBIL 0.001 0.023 0.001 1.001 0.956，1.048 0.970 DBIL -0.334 0.231 2.096 0.716 0.455，1.126 0.148 TC -0.028 0.108 0.065 0.973 0.787，1.202 0.799 TG 0.225 0.070 10.493 1.252 1.093，1.435 0.001 LDL-C -0.120 0.123 0.962 0.887 0.697，1.128 0.327 HDL-C -1.168 0.304 14.724 0.311 0.171，0.565 < 0.001 LDL-C/HDL-C 0.167 0.112 2.221 1.182 0.949，1.473 0.136 NEUT -0.001 0.025 0.000 0.999 0.952，1.049 0.982 LYM 0.246 0.152 2.608 1.279 0.949，1.724 0.106 MONO 0.770 0.479 2.587 2.159 0.845，5.515 0.108 RDW -0.190 0.099 3.655 0.827 0.681，1.005 0.056 Hb 0.018 0.006 8.384 1.018 1.006，1.03 0.004 EOS 0.588 0.426 1.903 1.801 0.781，4.154 0.168 FIB 0.511 0.172 8.894 1.668 1.192，2.334 0.003 PLT -0.003 0.002 2.979 0.997 0.994，1.000 0.084 G 0.101 0.037 7.371 1.106 1.028，1.189 0.007 NLR -0.032 0.028 1.305 0.968 0.917，1.023 0.253 MLR 0.086 0.475 0.032 1.089 0.429，2.764 0.857 PLR -0.002 0.001 3.651 0.998 0.995，1.000 0.056 MHR 1.426 0.402 12.565 4.163 1.892，9.159 < 0.001 NHR 0.193 0.049 15.634 1.213 1.102，1.335 < 0.001
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表 3 SHL患者初始听阈水平的多因素有序logistic回归分析
特征 β SE Wald χ2 OR 95%CI P值 男性 0.080 0.323 0.062 1.084 0.575，2.041 0.803 年龄 0.028 0.010 8.296 1.029 1.009，1.048 0.004 TG 0.082 0.070 1.370 1.086 0.946，1.246 0.242 HDL-C -0.191 0.412 0.215 0.826 0.368，1.852 0.643 Hb 0.002 0.008 0.064 1.002 0.986，1.018 0.800 FIB 0.284 0.185 2.341 1.328 0.923，1.910 0.126 G 0.051 0.037 1.900 1.052 0.979，1.130 0.168 MHR 0.091 0.469 0.038 1.096 0.437，2.746 0.845 NHR 0.138 0.061 5.205 1.148 1.020，1.293 0.023
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表 4 住院治疗结束时有效组和无效组的临床指标比较
特征 有效组 无效组 t/χ2/Z P值 人口学特征 年龄/岁 42.91±13.19 45.48±11.91 1.599 0.111 女/例(%) 97(55.43) 46(46.94) 1.815 0.178 男/例(%) 78(44.57) 52(53.06) 听力曲线类型 12.642 0.005 低频下降型/例(%) 55(31.43) 13(13.27) 高频下降型/例(%) 20(11.43) 13(13.27) 平坦下降型/例(%) 45(25.71) 39(39.80) 全聋型/例(%) 55(31.43) 33(33.67) 病史 耳鸣/例(%) 117(66.86) 70(71.43) 0.608 0.435 无耳鸣/例(%) 58(33.14) 28(28.57) 眩晕/例(%) 16(9.14) 70(71.43) 3.133 0.077 无眩晕/例(%) 159(90.86) 28(28.57) 初始听阈/dB HL 60(40，85) 67.5(46.75，91.25) -1.216 0.224 最终听阈/dB HL 30(20，60) 60(40，82) -6.868 < 0.001 病程/d 8.959 0.011 ≤7 123(70.29) 53(54.08) >7~14 31(17.71) 21(21.43) >14 21(12.00) 24(24.49) 左耳/耳(%) 83(47.43) 48(48.98) 0.061 0.806 右耳/耳(%) 92(52.57) 50(51.02) 血清胆红素 IBIL/(μmol·L-1) 8.37(5.97，11.3) 8.66(5.66，11.30) -0.076 0.939 TBIL/(μmol·L-1) 12.98(10.43，16.02) 13.14(11.20，15.96) -0.433 0.665 DBIL/(μmol·L-1) 0.30(0.30，0.30) 0.30(0.30，0.30) -0.673 0.501 血脂参数 TC/(mol·L-1) 4.61±1.04 4.67±0.94 0.423 0.673 TG/(mol·L-1) 1.29(0.78，2.36) 1.47(0.94，2.56) -1.421 0.155 LDL-C/(mol·L-1) 2.5(2.01，3.29) 2.61(2.18，3.18) -0.646 0.519 HDL-C/(mol·L-1) 1.21(0.99，1.50) 1.18(0.97，1.42) -0.841 0.401 LDL-C/HDL-C 2.11(1.49，2.91) 2.35(1.73，3.08) -0.989 0.323 其他血液学参数 NEUT(×109·L-1) 4.38(3.36，5.84) 4.81(3.42，6.60) -1.888 0.059 LYM(×109·L-1) 1.85(1.39，2.32) 1.79(1.37，2.19) -0.634 0.526 RBC(×109·L-1) 4.67(4.30，5.10) 4.81(4.41，5.09) -1.304 0.192 MONO(×109·L-1) 0.44(0.33，0.57) 0.435(0.33，0.57) -0.091 0.927 RDW/ % 12.60(12.10，13.10) 12.40(12.00，13.10) -1.058 0.290 Hb/(g·L-1) 142(130，155) 144(134，157.25) -1.384 0.166 EOS(×109·L-1) 0.07(0.02，0.16) 0.06(0.02，0.10) -1.695 0.090 FIB/(g·L-1) 2.81(2.39，3.22) 2.82(2.33，3.29) -0.058 0.953 PLT(×109·L-1) 253(207，302) 252(222.75，293.25) -0.363 0.717 G/(mmol·L-1) 5.9(5.02，7.43) 6.14(5.32，7.88) -1.346 0.178 NLR 2.26(1.61，3.24) 2.56(1.87，4.53) -1.977 0.048 MLR 0.23(0.17，0.29) 0.23(0.19，0.31) -1.198 0.231 PLR 129.82(102.95，176.27) 140.33(110.55，185.14) -1.256 0.209 MHR 0.35(0.25，0.54) 0.37(0.25，0.54) -0.423 0.673 NHR 3.6(2.52，5.25) 4.17(3.04，6.01) -2.078 0.038
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表 5 SHL临床相关指标与疗效的相关性分析
特征 Rs值 P值 NHR -0.126 0.037 听力曲线类型 -0.131 0.030 最终听阈 -0.416 < 0.001 病程 -0.148 0.015 NLR -0.120 0.048
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