2型糖尿病患者肾脏病变与听力损失的相关性
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摘要
目的通过比较2型糖尿病(type 2 diabetes mellitus,T2DM)患者在不同肾脏病阶段的听力情况,探讨糖尿病(diabetes mellitus,DM)肾病(diabetic nephropathy,DN)与听力损失的相关性。方法根据尿白蛋白排泄率(urinary albumin excretion rate,UAER)选择未合并肾病糖尿病组DM组40例、早期糖尿病肾病组(DNⅢ组) 28例、临床期糖尿病肾病组(DNⅣ组) 27例,并测定相应的肾小球滤过率及血肌酐浓度。采用对照研究的方法,通过纯音测听、声导抗检测,比较不同受试组听力水平差异。结果 DM组、DNⅢ组、DNⅣ组受试者听力损失检出率分别为60. 0%、71. 4%、92. 6%,且主要表现为高频听力损失,高频听力损失检出率分别为52. 5%、67. 9%、92. 6%,差异有统计学意义(P <0. 05)。纯音测听结果显示,随着检测频率的增高,各组受试者的听阈均呈升高趋势; DNⅢ组、DNⅣ组在所有检测频率的听阈均高于DM组(P <0. 01),在250、500、1 000、4 000 Hz范围内,各组的听阈DNⅣ组高于DNⅢ组高于DM组(P <0. 01)。相关分析显示,高频平均听阈与尿白蛋白排泄率水平呈正相关(r=0. 346,P=0. 001),与肾小球滤过率水平呈负相关(r=-0. 230,P=0. 025)。结论 2型糖尿病患者听力损失与肾脏病变存在相关性,随着肾脏病变的加重,听力损失发生的风险增高。发现糖尿病肾病的患者应积极进行听力筛查,以便能早期发现听力问题并给予及时的干预措施。
Objective To investigate the relationship between diabetic nephropathy( DN) and hearing loss in type 2 diabetes mellitus( T2 DM) patients with different stages of renal function by testing the performance on auditory function. Methods According to the urinary albumin excretion rate( UAER),40 patients with non-diabetic nephropathy( DM group),28 patients with early diabetic nephropathy( DN Ⅲ group),and 27 patients with clinical diabetic nephropathy( DN Ⅳ group) were collected in this study. The glomerular filtration rate( GFR) and creatinine( Cr) were simultaneously tested,and then the auditory function were compared via examination of the pure tone audiometry and a coustic immittance. Results The hearing loss in DM,DN Ⅲ and DN Ⅳ groups mainly occurred at high frequency,with incidence of 60. 0%,71. 4% and 92. 6%,respectively,The difference is statistically significant. Pure tone audiometry results suggested an increased trend in the hearing threshold with the increase of the frequency of detection. The hearing threshold of DN Ⅲ and DN Ⅳ groups were higher than DM group at all frequencies( P < 0. 01). The hearing threshold of DN Ⅳ group was higher than that of DN Ⅲ group,and DN Ⅲ group higher than DM group at 250,500,1 000,4 000 Hz( P < 0. 01). Correlation analysis showed that hearing threshold at high frequency was positively correlated with UAER( r = 0. 346,P = 0. 001),but negatively correlated with GFR( r =-0. 230,P = 0. 025). Conclusion Diabetic nephropathy was closely correlated with hearing loss in patients with type 2 diabetes mellitus,the risk of hearing loss increased with an exacerbation of kidney disease. The hearing screening of patientswith DN should be performed actively to detect hearing defectiveness and intervene at very early stage.
Objective To investigate the relationship between diabetic nephropathy( DN) and hearing loss in type 2 diabetes mellitus( T2 DM) patients with different stages of renal function by testing the performance on auditory function. Methods According to the urinary albumin excretion rate( UAER),40 patients with non-diabetic nephropathy( DM group),28 patients with early diabetic nephropathy( DN Ⅲ group),and 27 patients with clinical diabetic nephropathy( DN Ⅳ group) were collected in this study. The glomerular filtration rate( GFR) and creatinine( Cr) were simultaneously tested,and then the auditory function were compared via examination of the pure tone audiometry and a coustic immittance. Results The hearing loss in DM,DN Ⅲ and DN Ⅳ groups mainly occurred at high frequency,with incidence of 60. 0%,71. 4% and 92. 6%,respectively,The difference is statistically significant. Pure tone audiometry results suggested an increased trend in the hearing threshold with the increase of the frequency of detection. The hearing threshold of DN Ⅲ and DN Ⅳ groups were higher than DM group at all frequencies( P < 0. 01). The hearing threshold of DN Ⅳ group was higher than that of DN Ⅲ group,and DN Ⅲ group higher than DM group at 250,500,1 000,4 000 Hz( P < 0. 01). Correlation analysis showed that hearing threshold at high frequency was positively correlated with UAER( r = 0. 346,P = 0. 001),but negatively correlated with GFR( r =-0. 230,P = 0. 025). Conclusion Diabetic nephropathy was closely correlated with hearing loss in patients with type 2 diabetes mellitus,the risk of hearing loss increased with an exacerbation of kidney disease. The hearing screening of patientswith DN should be performed actively to detect hearing defectiveness and intervene at very early stage.
引文
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[13] Seidman M D,Khan M J,Bai U,et al. Biologic activity of mitochondrial metabolites on aging and age-related hearing loss[J]. Otol Neurotol,2000,21(2):161-167.
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[20] American Diabetes Association. 10. Microvascular complications and foot care[J]. Diabetes Care,2017,40(Suppl1):S88-S98.
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[24] Gratton M A,Rao V H,Meehan D T,et al. Matrix metalloproteinase dysregulation in the stria vascularis of mice with Alport syndrome:implications for capillary basement membrane pathology[J]. Am J Pathol, 2005,166(5):1465-1474.
[25] Lin S W,Lin Y S,Weng S F,et al. Risk of developing sudden sensorineural hearing loss in diabetic patients:a population-based cohort study[J]. Otol Neurotol,2012,33(9):1482-1488.
[26] Shen F C,Hsieh C J. Severity of hearing impairment is positively associated with urine albumin excretion rate in patients with type 2 diabetes[J]. J Diabetes Invest,2015,5(6):743-747.
[27]管益君,李金邦.肾小球疾病与听力关系的初步探讨[J].中华医学杂志,1990,70(6):338-342.
[28] Mitschke H,Schmidt P,Zazgornik J,et al. Effect of renal transplantation on uremic deafness:a long-term study[J].Audiology,1977,16(6):530-534.
[29] Ikeda K,Kusakari J,Arakawa E,et al. Cochlear potentials of guinea pigs with experimentally induced renal failure[J].Acta Otolaryngol Suppl,1987,435:40-45.
[30] Wei J L,Jin H Y,Ji H P,et al. Effect of rimonabant,the cannabinoid CB 1 receptor antagonist,on peripheral nerve in streptozotocin-induced diabetic rat[J]. Eur J Pharmacol,2010,637(1-3):70-76.
[31] Austin D F,Dawn K M,Susan G,et al. Diabetes-related changes in hearing[J]. Laryngoscope,2009,119(9):1788-1796.
[32] Konrad Martin D,Austin D F,Griest S,et al. Diabetes related changes in auditory brainstem responses[J]. Laryngoscope,2010,120(1):150-158.
[33] Aladag I,Eyibilen A M. Role of oxidative stress in hearing impairment in patients with type two diabetes mellitus[J]. J Laryngol Otol,2009,123(123):957-963.
[34]汪晶华,迟雁青,杨新军,等.血清Irisin及其基因多态性与糖尿病肾病患者微血管病变的相关性[J].解放军医药杂志,2018,30(4):51-53,60.
[35]卢彬,段金萍,孟岩,等.糖调节异常与听力损害[J].首都医科大学学报,2015,36(1):98-102
[2] Bainbridge K E,Hoffman H J,Cowie C C. Diabetes and hearing impairment in the United States:audiometric evidence from the national health and nutrition examination survey,1999 to 2004[J]. Ann Intern Med,2008,149(1):1-10.
[3] Sunkum A J,Pingile S. A clinical study of audiological profile in diabetes mellitus patients[J]. Eur Arch OtorhinoLaryngol,2013,270(3):875-879.
[4] Satofumi S,Teranish M,Fukunage T,et al. Contributing factors to hearing of diabetic patients in an in-hospital education program[J]. Acta Otolaryngol,2013,133(11):1165-1172.
[5] Mogensen C E. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes[J]. N Engl J Med,1984,310(6):356-360.
[6]卜行宽,刘铤.世界卫生组织预防聋和听力减退工作情况介绍[J].中华耳鼻咽喉头颈外科杂志,2000,35(3):237-239.
[7] Chika H,Satoru K,Shiro T,et al. Diabetes and risk of hearing impairment in adults:a meta-analysis[J]. J Clin Endocr Metab,2013,98(1):51-58.
[8] Panchu P. Auditory acuity in type 2 diabetes mellitus[J].Int J Diabetes Dev C,2008 28(4):114-120.
[9] Akinpelu O V,Mario M M,Daniel S J. Is type 2 diabetes mellitus associated with alterations in hearing? A systematic review and meta-analysis[J]. Laryngoscope,2014,124(3):767-776.
[10] Vaughan N,James K D,Griest S,et al. A 5-year prospective study of diabetes and hearing loss in a veteran population[J]. Otol Neurotol,2006,27(1):37-43.
[11]龚敬,刘博.糖尿病患者听力损失的相关研究[J].中华耳鼻咽喉头颈外科杂志,2014,49(9):781-785.
[12]曹永茂,陶泽璋,罗志宏,等.不同人群高频听力测试结果分析[J].中国听力语言康复科学杂志,2005,13(6):23-25.
[13] Seidman M D,Khan M J,Bai U,et al. Biologic activity of mitochondrial metabolites on aging and age-related hearing loss[J]. Otol Neurotol,2000,21(2):161-167.
[14] Madan R,Gupt B,Saluja S,et al. Coagulation profile in diabetes and its association with diabetic microvascular complications[J]. J Assoc Physicians India,2010,58(8):481-484.
[15] Tomisawa H. Diabetic changes in the stria vascularis in humans—a study of PAS-stained temporal bone sections[J]. Nippon Jibiinkoka Gakkai Kaiho,2000,103(11):1227-1237.
[16] Fukushima H,Cureoglu S,Schachern P A,et al. Effects of type 2 diabetes mellitus on cochlear structure in humans[J]. Arch Otolaryngol Head Neck Surg,2006,132(9):934-938.
[17]钱永忠,感音神经性听力损失、眩晕及耳鸣诊疗指南[M].上海:第二军医大学出版社,2005:170-180.
[18] Marcos S,Burns S A,Prieto P M,et al. Investigating sources of variability of monochromatic and transverse chromatic aberrations across eyes[J]. Vision Res,2002,41(28):3861-3871.
[19] Howes T,Madden C S,Saeed S,et al. Role of mitochondrial variation in maternally inherited diabetes and deafness syndrome[J]. J Laryngol Otol, 2008,122(11):1249-1252.
[20] American Diabetes Association. 10. Microvascular complications and foot care[J]. Diabetes Care,2017,40(Suppl1):S88-S98.
[21] Zhang L,Long J,Jiang W,et al. Trends in chronic kidney disease in China[J]. N Engl J Med,2016. 375(9):905-906.
[22] Balakumar P,Arora M K,Ganti S S,et al. Recent advances in pharmacotherapy for diabetic nephropathy:current perspectives and future directions[J]. Pharmacol Res,2009,60(60):24-32.
[23] Bainbridge K E,Cowie C C,Gonzalez F 2nd,et al. Risk factors for hearing impairment among adults with diabetes:the hispanic community health study/study of latinos(HCHS/SOL)[J]. J Clin Translat Endocrinol,2016,6:15-22.
[24] Gratton M A,Rao V H,Meehan D T,et al. Matrix metalloproteinase dysregulation in the stria vascularis of mice with Alport syndrome:implications for capillary basement membrane pathology[J]. Am J Pathol, 2005,166(5):1465-1474.
[25] Lin S W,Lin Y S,Weng S F,et al. Risk of developing sudden sensorineural hearing loss in diabetic patients:a population-based cohort study[J]. Otol Neurotol,2012,33(9):1482-1488.
[26] Shen F C,Hsieh C J. Severity of hearing impairment is positively associated with urine albumin excretion rate in patients with type 2 diabetes[J]. J Diabetes Invest,2015,5(6):743-747.
[27]管益君,李金邦.肾小球疾病与听力关系的初步探讨[J].中华医学杂志,1990,70(6):338-342.
[28] Mitschke H,Schmidt P,Zazgornik J,et al. Effect of renal transplantation on uremic deafness:a long-term study[J].Audiology,1977,16(6):530-534.
[29] Ikeda K,Kusakari J,Arakawa E,et al. Cochlear potentials of guinea pigs with experimentally induced renal failure[J].Acta Otolaryngol Suppl,1987,435:40-45.
[30] Wei J L,Jin H Y,Ji H P,et al. Effect of rimonabant,the cannabinoid CB 1 receptor antagonist,on peripheral nerve in streptozotocin-induced diabetic rat[J]. Eur J Pharmacol,2010,637(1-3):70-76.
[31] Austin D F,Dawn K M,Susan G,et al. Diabetes-related changes in hearing[J]. Laryngoscope,2009,119(9):1788-1796.
[32] Konrad Martin D,Austin D F,Griest S,et al. Diabetes related changes in auditory brainstem responses[J]. Laryngoscope,2010,120(1):150-158.
[33] Aladag I,Eyibilen A M. Role of oxidative stress in hearing impairment in patients with type two diabetes mellitus[J]. J Laryngol Otol,2009,123(123):957-963.
[34]汪晶华,迟雁青,杨新军,等.血清Irisin及其基因多态性与糖尿病肾病患者微血管病变的相关性[J].解放军医药杂志,2018,30(4):51-53,60.
[35]卢彬,段金萍,孟岩,等.糖调节异常与听力损害[J].首都医科大学学报,2015,36(1):98-102