先天感音神经性聋脑白质微观结构变化及其与人工耳蜗术后疗效的相关性分析  

Microstructural Changes of White Matter in Congenital Sensorineural Hearing Loss and Its Correlation with Efficacy of Cochlear Implantation

作　　者：何盛梅 李昌亚 卓贤露 王晓云[1,2] 赵厚育 HE Shengmei;LI Changya;ZHUO Xianlu;WANG Xiaoyun;ZHAO Houyu(Department of Otorhinolaryngology Head and Neck Surgery,Affiliated Hospital of Guizhou Medical University,Guizhou,Guiyang,550004;Clinical Medical College of Guizhou Medical University,Guizhou,Guiyang,550004;Department of Otorhinolaryngology Head and Neck Surgery,the Southwest Hospital of the Third Military University of Medicine,Chongqing,400038)

机构地区：[1]贵州医科大学附属医院耳鼻咽喉头颈外科,贵阳550004 [2]贵州医科大学临床医学院,贵阳550004 [3]第三军医大学西南医院耳鼻咽喉科,重庆400038

出　　处：《中华耳科学杂志》2022年第2期277-282,共6页Chinese Journal of Otology

基　　金：贵州省卫生健康委员会科学技术基金项目(gzwjkj2020-1-153);2020年国家自然科学基金培育项目(I-2020-10);贵州省科技计划项目[黔科合J字(2009)2325]~。

摘　　要：目的 分析CSNHL患儿脑白质纤维束的FA值及影响因素,探讨FA值与人工耳蜗植入术后前语言交流能力的相关性。方法 收集2019.09-2020.01行人工耳蜗植入术的CSNHL患儿和与之年龄相匹配的听力正常儿童,利用DTI成像技术获得各脑白质纤维束的FA值,于人工耳蜗植入开机后1、3、6、9、12月评估CSNHL患儿的前语言交流能力。结果 1. CSNHL患儿双侧皮质脊髓束、双侧扣带、枕钳、左侧上纵束、右侧钩束、双侧下纵束、双侧下额枕束的FA值均降低(P<0.05),以右下额枕束和右下纵束FA值降低最为显著(P<0.01);2.助听组CSNHL患儿右下额枕束和右下纵束的FA值大于无助听组(P<0.05),而助听+语训组的FA值大于单纯助听组(P<0.05);3.CSNHL患儿术后前语言交流能力各项指标评估得分与术前患儿右下额枕束和右下纵束的FA值均存在正相关。结论 CSNHL患儿脑白质各纤维束FA值普遍降低;早期助听或助听后同步进行语训可能影响CSNHL患儿中枢脑白质FA值改变,减少听觉剥夺;术前FA值可能作为一种人工耳蜗植入术后听觉言语康复效果的潜在评估指标,对术后疗效可能具有一定预判作用。Objective To report the FA value of white matter fiber tracts in children with congenital sensorineural hearing loss(CSNHL) and influencing factors to identify its potential correlation with pre-linguistic communication skills after cochlear implantation. Methods Data from children with CSNHL who underwent cochlear implantation and age-matched normal hearing children were collected from September 2019 to January 2020. Fractional anisotropy(FA)values of white matter fiber bundles were obtained via diffusion tensor imaging(DTI). Pre-linguistic communication ability was evaluated in children with CSNHL at 1, 3, 6, 9 and 12 months after cochlear implantation. Results Compared to their normal hearing peers, children with CSNHL showed decreased FA values in bilateral corticospinal tract,bilateral cingulum, forceps major, left superior longitudinal fasciculus, right uncinate fasciculus, bilateral inferior longitudinal fasciculus and bilateral inferior fronto-occipital fasciculus(P<0.05), especially so in the right inferior fronto-occipital fasciculus and inferior longitudinal fasciculus(P<0.01), which were higher in aided children than in the non-aided children(P<0.05) and yet higher in aided and language rehabilitated children than in aided only children(P<0.05).The pre-linguistic communication ability score in children with CSNHL were positively correlated with FA values of the right inferior fronto-occipital fasciculus and the right inferior longitudinal fasciculus. Conclusion FA values of white matter fiber bundles in children with CSNHL are generally decreased. Early wea hearing aid fitting, especially when combined with simultaneous language training, may impact white matter FA values in these children and alleviate hearing deprivation. FA values may be used as a potential index to evaluate the effect of hearing and speech rehabilitation after cochlear implantation, and may be used to predict outcomes after cochlear implantation.

关 键 词：先天感音神经性聋 扩散张量成像 人工耳蜗 前语言交流能力 视频分析 

分 类 号：R764[医药卫生—耳鼻咽喉科]