补体C3、C4、抗凝蛋白及血液流变学与突发性耳聋发病及预后相关性分析  

Correlation among Complements C3 and C4,Anticoagulant Proteins,Hemorheology and Onset and Prognosis of Sudden Deafness

作　　者：张梦君 戴嵩 唱得龙 ZHANG Mengjun;DAI Song;CHANG Delong(Department of Otolaryngology Head and Neck Surgery,Northeast International Hospital,Shenyang 110000,China)

机构地区：[1]东北国际医院耳鼻咽喉头颈外科,沈阳110000

出　　处：《中华耳科学杂志》2022年第4期554-559,共6页Chinese Journal of Otology

摘　　要：目的 观察免疫指标、抗凝蛋白及血液流变学参数在突发性耳聋患者中变化及与疗效预后关系。方法以2018年1月~2020年12月236例突发性耳聋住院患者为突聋组(包括双侧组48例、单侧组188例)、同期120例健康体检者为对照组,比较突聋组与对照组免疫指标(补体C3、C4)水平、抗凝蛋白(蛋白C、蛋白S、抗凝血酶Ⅲ活性及血液流变学(血浆粘度、全血高切粘度、红细胞聚集指数、纤维蛋白原)参数,并分析上述指标与平均听阈关系;患者根据疗效分为有效组160例、无效组76例,采用多因素Logistic回归分析探究影响疗效预后因素。结果 突聋双侧组、单侧组补体C3、C4均较对照组明显下降(P<0.05),且双侧组补体C3、C4均较单侧组下降(P<0.05);突聋双侧组、单侧组PC、PS活性均较对照组明显下降(P<0.05),且双侧组PC、PS活性均较单侧组下降(P<0.05);突聋双侧组、单侧组血浆粘度、全血高切粘度、RCAI、FIB水平均较对照组明显升高(P<0.05),但双侧组与单侧组上述指标无明显差异(P>0.05)。Pearson相关分析显示,突聋患者血浆粘度与平均听阈呈正相关(P<0.05),补体C3、C4、PC活性均与平均听阈呈负相关(P<0.05);多因素Logistic回归分析显示,双侧发病、平均听阈71~90 dB HL、全聋型、补体C3下降、PC活性下降、血浆粘度升高是患者无效的独立危险因素(P<0.05)。结论 突发性耳聋患者存在免疫、抗凝及血液流变学异常,且与病情严重程度及疗效预后有一定关系,其中补体C3下降、PC活性下降、血浆粘度升高是患者无效的独立危险因素。Objective To record changes of immune indicators,anticoagulant proteins and hemorheological parameters in patients with sudden deafness and analyze their relationship with treatment outcomes.Methods Patients with sudden deafness hospitalized between January 2018 and December 2020(n=236,48 bilateral) were included as the study group,and 120 healthy subjects identified during the same period as the control group.Levels of immune indicators(complements C3 and C4),activities of anticoagulant proteins(protein C,protein S and antithrombin III) and hemorheological parameters(plasma viscosity,whole blood high-shear viscosity,red blood cell aggregation index,fibrinogen) were compared between the two groups,and their relationship with hearing thresholds was analyzed.Treatment outcomes were categorized as effective(n=160) and ineffective(n=76).Multivariate logistic regression analysis was used to identify factors affecting treatment efficacy and outcomes.Results Levels of C3 and C4 and PC and PS activities were significantly lower in patients with bilateral or unilateral sudden deafness compared with healthy subjects(P0.05).Pearson correlation analysis showed that plasma viscosity was positively correlated with hearing thresholds(P<0.05)and C3 and C4 and PC levels were negatively correlated with hearing thresholds(P<0.05) in patients with sudden deafness.Multivariate Logistic regression analysis showed that bilateral involvement,hearing threshold in the range of 71~90 dB HL,total hearing loss,decreased C3,reduced PC activity and increased plasma viscosity were independent risk factors for lack of response to treatment(P<0.05).Conclusion Abnormal immune responses,coagulation and hemorheology are involved in sudden deafness and related to the severity of disease and response to treatment.Among them,decrease of C3,reduced PC activity and increase of plasma viscosity are the independent risk factors for lack of response to treatment.

关 键 词：突发性耳聋 免疫 抗凝蛋白 血液流变学 疗效预后 临床相关性 

分 类 号：R764[医药卫生—耳鼻咽喉科]