静脉源性搏动性耳鸣随访期间症状改变的血流动力学机制探究  

Exploring the hemodynamic mechanisms of symptomatic changes in venous pulsatile tinnitus during follow-up

作　　者：吕珂 王慧颖 柴超 徐开旭 夏爽 LV Ke;WANG Hui-ying;CHAI Chao;XU Kai-xu;XIA Shuang(Tianjin First Central Hospital,School of Medicine,Nankai University,Tianjin 300380,China)

机构地区：[1]天津市第一中心医院,南开大学医学院,天津300380

出　　处：《中国临床医学影像杂志》2023年第12期845-850,共6页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金项目(82171916);天津市卫生健康科技项目重点学科专项(TJWJ2022XK019)。

摘　　要：目的:旨在明确静脉源性搏动性耳鸣(Venous pulsatile tinnitus,VPT)的症状严重程度随时间变化的改变趋势,并探究非手术干预状态下VPT患者耳鸣严重程度改变的预测因素。方法:本研究纳入59位单侧VPT患者及51位健康志愿者。应用4D flow MRI评估横窦-乙状窦的血流动力学情况,应用颞骨HRCT评估乙状窦周围骨壁缺失(Sigmoid sinus wall dehiscence,SSWD)大小。设计基线、1月、6月耳鸣残障量表问卷随访调查。分析基线时血流动力学特征以及SSWD的大小对随访期间患者症状严重程度变化的预测意义。结果:相较于健康志愿者,VPT组患者有着较高的峰值流速(P<0.001)、管壁切应力(P<0.001)、能量损失(P<0.001)。随访期间,43例(72.9%)患者在6月时(P<0.001)症状加重。逐步线性回归模型显示,基线峰值流速分别是1月随访(β=0.545,P<0.001)及6月随访(β=0.699,P<0.001)耳鸣严重程度的独立危险因素。Logistic模型显示SSWD(β=0.179,P=0.018)和峰值流速(β=0.030,P=0.040)可以作为预测VPT患者症状加重的独立预测因子。结论:大多数非手术干预状态下的VPT患者耳鸣症状在半年内都有不同程度的加重。较高的峰值流速和SSWD可以预测VPT患者6月后的耳鸣症状加重,4D flow MRI提供的血流动力学参数可以作为VPT患者症状动态变化的预测因素,这为临床治疗决策的制定提供了有力的参考依据。Objective:The aim of this study is to clarify the change of symptom severity over time in venous pulsatile tinnitus(VPT)patients and to explore predictive factors for tinnitus severity changes in non-surgical intervention VPT patients.Method:This study included 59 unilateral VPT patients and 51 healthy volunteers.4D flow MRI was used to evaluate the hemodynamic status of the transverse and sigmoid sinuses,and temporal bone HRCT was used to evaluate the size of sigmoid sinus wall dehiscence(SSWD).Design baseline,1 month and 6 months tinnitus handicap inventory follow-up.Analyze the impact of baseline hemodynamic characteristics and the size of SSWD on the severity of symptoms in patients during followup and its predictive significance.Result:Compared with healthy volunteers,VPT patients had higher peak velocity(P<0.001),wall shear stress(P<0.001)and energy loss(P<0.001).During the follow-up period,most VPT patients experienced worsening symptoms in 1 month(P=0.001)and 6 months(P<0.001).The stepwise linear regression model showed that the baseline peak velocity can be used as independent risk factor for the severity of tinnitus in both 1 month follow-up(β=0.545,P<0.001)and 6 months follow-up(β=0.699,P<0.001).Logistic model displayed SSWD(β=0.179,P=0.018)and peak velocity(β=0.030,P=0.040)can be used as an independent predictor of symptom exacerbation in VPT patients.Conclusion:Most non-surgical intervention VPT patients have poor prognosis.Higher peak velocity and SSWD can predict the worsening of tinnitus symptoms in VPT patients after 6 months.The hemodynamic parameters provided by 4D flow MRI can be used as predictive factors of dynamic changes in tinnitus symptoms in VPT patients provides a powerful reference for clinical treatment decision-making.

关 键 词：耳鸣 体层摄影术 X线计算机 磁共振成像 

分 类 号：R764.45[医药卫生—耳鼻咽喉科] R814.42[医药卫生—临床医学] R445.2