Evaluation of the montreal cognitive assessment in idiopathic tinnitus patients with mild hearing loss
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摘要: 目的 通过轻度听力损失的特发性耳鸣患者蒙特利尔认知量表(MoCA)评估，探讨轻度听力损失对特发性耳鸣患者认知功能的影响。方法 选取以耳鸣为第一主诉的特发性耳鸣患者102例(根据听力水平分为听力正常组68例和轻度听力损失组34例)和34例健康志愿者，采集病史、纯音测听、耳鸣匹配及掩蔽测试结果等临床资料，并进行MoCA、耳鸣致残量表(THI)、焦虑自评量表(SAS)、抑郁自评量表(SDS)和匹兹堡睡眠指数(PQSI)等量表评估。比较各组间临床特征和各量表得分。结果 听力正常的特发性耳鸣患者MoCA总分和各维度得分均显著低于正常人群(P < 0.05)；轻度听力损失与听力正常的特发性耳鸣患者比较，年龄更大(P < 0.01)，MoCA总分更低(P < 0.05)；均衡混杂因素(年龄、性别、受教育年限、耳鸣患病时长、耳鸣音调频率，耳鸣侧别、THI评分、SAS评分、SDS评分和PQSI评分)后，听力正常和轻度听力损失的耳鸣患者的MoCA总分无显著性差异(P>0.05)；轻度听力损失的特发性耳鸣患者在注意力和工作记忆维度评分显著低于听力正常的特发性耳鸣患者(P < 0.01)。结论 特发性耳鸣患者可能存在认知功能障碍，轻度听力损失可能不是促进特发性耳鸣患者认知功能障碍进一步加重的因素，听力损失在特发性耳鸣患者认知功能障碍中的作用有待进一步研究。Abstract: Objective To explore the effect of mild hearing loss on cognitive function by evaluating the Montreal Cognitive Assessment(MoCA) in idiopathic tinnitus patients with mild hearing loss.Methods 102 patients with idiopathic tinnitus(68 patients with normal hearing and 34 patients with mild hearing loss) whose first complaint is tinnitus and 34 healthy volunteers(control group) were included. All subjects were asked to fill the MoCA, Tinnitus Handicap Inventory(THI), Self-rating Anxiety Scale(SAS), Self-rating Depression Scale(SDS), and Pittsburgh Sleep Index(PQSI) after collecting medical history, pure tone audiometry, tinnitus matching and masking test. The clinical characteristics and scores of each scale were compared among the groups.Results The score and each dimension score of MoCA in idiopathic tinnitus patients with normal hearing were significantly lower than the normal population(P < 0.05); compared with patients with idiopathic tinnitus with normal hearing, patients with mild hearing loss were older(P < 0.01) and had lower MoCA scores(P < 0.05). There was no significant difference in MoCA scores(P>0.05) between tinnitus patients with normal hearing and mild hearing loss after correcting confounding factors(age, gender, years of education, duration of tinnitus, frequency of tinnitus tones, side of tinnitus, THI score, SAS score, SDS score, and PQSI score); idiopathic tinnitus patients with mild hearing loss scored significantly lower in attention and working memory dimensions than idiopathic tinnitus patients with normal hearing(P < 0.01).Conclusion Patients with idiopathic tinnitus may have cognitive dysfunction, and mild hearing loss may not be a factor that promotes the further aggravation of cognitive dysfunction in patients with idiopathic tinnitus. The role of hearing loss in cognitive dysfunction in patients with idiopathic tinnitus needs further research.
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表 1 一般临床资料
变量 TIN+NH组(n=68) TIN+HL组(n=34) HC组(n=34) 统计量 P 年龄/岁 39.5(32.3，50.0) 52.0(49.7，58.5) 36.0(36.7，46.1) H=26.42 < 0.001 性别(男/女)/例 30/38 16/18 18/16 χ2=0.71 0.702 较好耳听阈/dB a 12.36±4.49 25.88±4.20 8.93±4.78 F=142.18 < 0.001 较差耳听阈/dB b 16.40±5.76 29.78±4.50 11.76±5.52 F=105.24 < 0.001 受教育年限/年 12.9(9.7，16.0) 12.4(8.8，15.4) 13.5(11.0，16.0) H=2.08 0.352 注：a：听力较好耳在500、1 000、2 000和4 000 Hz的平均纯音听阈；b：听力较差耳在500、1 000、2 000和4 000 Hz的平均纯音听阈。 
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表 2 听力正常和轻度听力损失的特发性耳鸣患者耳鸣特征及其他临床数据
变量 TIN+NH组(n=68) TIN+HL组(n=34) 统计量 P 耳鸣侧别(左/右/双) 10/17/41 7/6/21 χ2=1.02 0.600 病程/月 13.5(11.3，36.0) 12.0(9.0，54.0) t=0.33 0.742 耳鸣频率(低/中/高)a 14/24/30 4/17/13 χ2=3.68 0.159 耳鸣听力级响度/dB HL 34(27.3，45.0) 53.5(40.8，66.5) t=4.79 < 0.001 耳鸣感觉级响度/dB SL 14.0(8.1，20.8) 10.0(6.5，18.5) t=1.03 0.305 THI评分 23.0(14.0，38.5) 23.0(14.0，39.0) t=1.67 0.867 SAS评分 25.5(23.0，29.0) 23.0(21.8，27.0) t=1.95 0.051 SDS评分 26.0(22.0，30.3) 24.0(22.0，29.3) t=0.92 0.356 PQSI评分 8.99±4.00 8.85±4.05 t=0.16 0.832 注：a：低频：≤1 000 Hz，中频：1 001~4 000 Hz，高频：>4 000 Hz。
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表 3 听力正常的特发性耳鸣患者和健康对照组的MoCA量表评分比较
MoCA评分 TIN+NH组(n=68) HC组(n=34) t P MoCA总分 22.9(20.4，25.3) 27.5(26.4，28.5) 6.14 < 0.001 短时记忆 3.1(1.7，4.0) 4.0(3.3，4.6) 3.72 < 0.001 视空间能力 2.8(2.1，3.6) 3.3(2.7，3.9) 2.71 0.007 执行功能 2.5(1.7，3.4) 3.7(3.2，4.0) 5.80 < 0.001 注意力和工作记忆 5.7(5.2，6.0) 5.9(5.3，6.0) 2.18 0.029 语言 3.3(2.3，4.4) 4.6(4.1，5.0) 5.08 < 0.001 定向力 5.8(5.3，6.0) 6.0(6.0，6.0) 2.95 0.003
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表 4 IPTW前后各种变量分布
变量 IPTW前 IPTW后 NH HL P NH HL P 例数 68 34 98.69 115.34 年龄/岁 39.5(32.3，50.0) 52.0(49.7，58.5) < 0.001 43.58±11.43 40.83±14.03 0.573 性别 0.944 0.726 男 38(55.9) 18(52.9) 53.0(53.7) 68.3(59.2) 女 30(44.1) 16(47.1) 45.7(46.3) 47.1(40.8) 耳鸣侧别 0.600 0.687 左 10(14.7) 7(20.6) 15.2(15.4) 16.4(14.2) 右 17(25.0) 6(17.6) 22.7(23.0) 17.2(14.9) 双 41(60.3) 21(61.8) 60.8(61.6) 81.7(70.9) 病程/月 13.5(11.3，36.0) 12.0(9.0，54.0) 0.741 29.44±30.59 28.30±45.94 0.900 耳鸣频率 0.300 0.779 低 14(20.6) 4(11.8) 17.3(17.5) 12.2(10.6) 中 24(35.3) 17(50.0) 40.1(40.7) 50.0(43.4) 高 30(44.1) 13(38.2) 41.3(41.8) 53.1(46.0) THI 23.0(14.0，38.5) 23.0(14.0，39.0) 0.867 27.01±16.15 24.69±13.65 0.497 SAS 25.5(23.0，29.0) 23.0(21.8，27.0) 0.051 26.68±6.13 25.61±4.98 0.332 SDS 26.0(22.0，30.3) 24.0(22.0，29.3) 0.356 27.24±6.22 26.92±4.82 0.790 受教育年限/年 12.9(9.7，16.0) 12.4(8.8，15.4) 0.350 12.54±3.74 12.01±3.69 0.639 PQSI 8.99(4.00) 8.85(4.05) 0.876 8.91±4.12 8.37±3.85 0.601 MoCA 22.9(20.4，25.3) 20.2(17.9，24.5) 0.019 22.47±3.56 20.83±4.04 0.218 短时记忆 3.1(1.7，4.0) 2.0(0.9，3.1) 0.013 2.77±1.53 2.40±1.50 0.371 视空间能力 2.8(2.1，3.6) 2.4(1.6，3.3) 0.074 2.75±0.91 2.63±0.88 0.578 执行功能 2.5(1.7，3.4) 2.2(1.4，3.0) 0.137 2.39±1.07 1.87±1.33 0.331 注意力和工作记忆 5.7(5.2，6.0) 5.4(4.7，6.0) 0.051 5.68±0.61 5.22±0.78 0.003 语言 3.3(2.3，4.4) 3.1(2.1，4.0) 0.360 3.14±1.18 3.10±1.28 0.928 定向力 5.8(5.3，6.0) 5.8(5.3，6.0) 0.868 5.73±0.45 5.59±0.50 0.435
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