脑小血管病与突发性感音神经性聋的相关性  

Correlation between cerebral small vessel disease and sudden sensorineural hearing loss

作　　者：李浩然 石宝洋 朱利利 刘勇 高明[3] 付胜奇 Li Haoran;Shi Baoyang;Zhu Lili;Liu Yong;Gao Ming;Fu Shengqi(Department of Neurology,the Fifth Clinical Medical College,Henan University of Chinese Medicine(Zhengzhou People's Hospital),Zhengzhou 450003,China;Department of Medical Imaging,the Fifth Clinical Medical College,Henan University of Chinese Medicine(Zhengzhou People's Hospital),Zhengzhou 450003,China;Department of Otolaryngology Head and Neck surgery,the Fifth Clinical Medical College,Henan University of Traditional Chinese Medicine(Zhengzhou People's Hospital),Zhengzhou 450003,China)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)神经内科,郑州450003 [2]河南中医药大学第五临床医学院(郑州人民医院)医学影像科,郑州450003 [3]河南中医药大学第五临床医学院(郑州人民医院)耳鼻咽喉头颈外科,郑州450003

出　　处：《国际脑血管病杂志》2023年第6期429-434,共6页International Journal of Cerebrovascular Diseases

基　　金：河南省医学科技攻关计划省部共建项目(SB201903029)。

摘　　要：目的探讨脑小血管病(cerebral small vessel disease,CSVD)总体负担评分与突发性感音神经性聋(sudden sensorineural hearing loss,SSNHL)及其严重程度的关系。方法回顾性纳入2019年1月至2022年6月期间郑州人民医院收治的SSNHL患者作为病例组,年龄和性别相匹配的紧张性头痛或良性位置性眩晕患者作为对照组。采用MRI评估CSVD表型,包括脑白质高信号(white matter hyperintensities,WMHs)、脑微出血(cerebral microbleeds,CMBs)、血管周围间隙扩大(enlarged perivascular space,EPVS)和血管源性腔隙,然后计算CSVD总体负担评分。应用多变量logistic回归分析确定SSNHL的独立影响因素,通过有序多分类变量logistic回归分析探讨CSVD总体负担与SSNHL患者听力受损严重程度的关系。结果共纳入86例SSNHL患者以及90例年龄和性别相匹配的对照者。两组甘油三酯、高密度脂蛋白胆固醇、空腹血糖水平、WMHs总体评分分类、脑室周围WMHs评分分类、深部WMHs评分分类、CMBs、中重度EPVS、CSVD总体负担评分及分类差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,校正高密度脂蛋白胆固醇后,空腹血糖≥6.1 mmol/L[优势比(odds ratio,OR)2.149,95%置信区间(confidence interval,CI)1.042~4.432;P=0.038]、甘油三酯≥1.7 mmol/L(OR 7.012,95%CI 2.962~16.597;P=0.000)、CSVD总体负担评分>1分(与0分相比,2分:OR 4.095,95%CI 1.364~12.291,P=0.012;3分:OR 5.776,95%CI 1.888~17.614,P=0.002;4分:OR 7.900,95%CI 2.526~24.706;P=0.000)与SSNHL显著独立相关。有序多分类变量logistic回归分析显示,校正年龄和空腹血糖后,平坦下降型听力损失(OR 1.276,95%CI 1.131~1.618;P=0.044)和全聋型听力损失(OR 1.029,95%CI 1.002~1.058;P=0.038)以及CSVD总体负担为中度(OR 1.318,95%CI 1.036~1.677;P=0.025)和重度(OR 2.330,95%CI 1.232~4.406;P=0.009)与SSNHL患者听力损伤程度显著独立相关。结论CSVD总体负担中重度与SSNHL独立相关,且与SSNHL患者听力损伤程度独�Objective To investigate the relationship between the overall burden score of cerebral small vessel disease(CSVD)and sudden sensorineural hearing loss(SSNHL)and its severity.Methods Patients with SSNHL admitted to Zhengzhou People’s Hospital from January 2019 to June 2022 were used as the case group,and age-and gender-matched patients with tension headache or benign positional vertigo were used as the control group.MRI was used to evaluate the phenotype of CSVD,including white matter hyperintensities(WMHs),cerebral microbleeds(CMBs),enlarged perivascular spaces(EPVS),and lacune of presumed vascular origin,and then the total burden score of CSVD was calculated.Multivariate logistic regression analysis was used to determine the independent factors of SSNHL.Ordinal logistic regression analysis was used to investigate the relationship between the overall burden of CSVD and the severity of hearing loss in patients with SSNHL.Results A total of 86 patients with SSNHL and 90 age-and gender-matched controls were included.There were statistically significant differences in triglycerides,high-density lipoprotein cholesterol,fasting blood glucose levels,WMHs overall score classification,periventricular WMHs score classification,deep WMHs score classification,CMBs,moderate to severe EPVS,CSVD overall burden score and classification between the two groups(all P<0.05).Multivariate logistic regression analysis showed that after adjusting for high-density lipoprotein cholesterol,fasting blood glucose≥6.1 mmol/L(odds ratio[OR]2.149,95%confidence interval[CI]1.042-4.432;P=0.038),triglycerides≥1.7 mmol/L(OR 7.012,95%CI 2.962-16.597;P=0.000),CSVD overall burden score>1(compared to 0 point,2 points:OR 4.095,95%CI 1.364-12.291,P=0.012;3 points:OR 5.776,95%CI 1.888-17.614,P=0.002;4 points:OR 7.900,95%CI 2.526-24.706;P=0.000)were significantly independently correlated with SSNHL.Ordinal logistic regression analysis showed that after adjusting for age and fasting blood glucose,the flat decline type hearing loss(OR 1.276,95%CI 1.131

关 键 词：脑小血管疾病 听力损失 突发性 听力损失 感音神经性 磁共振成像 

分 类 号：R743[医药卫生—神经病学与精神病学]