血浆纤维蛋白原水平与不同类型突发性聋的发病相关性探讨
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摘要
目的:探讨血浆纤维蛋白原水平与不同类型突发性聋(突聋)的相关性。方法:选择225例诊断明确的突聋患者,纳入标准为年龄18～70周岁,病程<2周,未经任何相关医疗处理的突聋患者(突聋组)。按照听力曲线分为低频下降型、高频下降型、平坦下降型和全聋型4种类型;另选择229例在同一时期听力正常且无炎症性疾病的住院患者为正常对照组。分别采集血浆纤维蛋白原检查,比较2组的检查指标,行回顾性队列分析。结果:突聋组血浆纤维蛋白原均值为(2.98±0.59)g/L,明显高于对照组(2.66±0.36)g/L,差异有统计学意义(P<0.001);根据听力分型:低频下降型55例(24.44%),高频下降型36例(16.00%),平坦下降型43例(19.11%),全聋型91例(40.44%),治疗前各型血浆纤维蛋白原均值分别为(2.75±0.46)g/L,(3.16±0.61)g/L,(3.02±0.63)g/L,(3.03±0.63)g/L。不同听力类型的纤维蛋白原水平与对照组进行比较,其中低频下降型组与对照组比较差异无统计学意义(P=0.286);高频下降型组、平坦下降型组、全聋型组纤维蛋白原水平显著高于对照组,差异有统计学意义(P<0.001)。结论:低频下降型突聋发病与纤维蛋白原水平的高低无明显相关性,高频下降型、平坦下降型、全聋型突聋的发生均与发病时高纤维蛋白原水平有关。根据不同听力曲线对突聋进行分型,对于分析突聋发生的可能病因及选择不同的治疗方案有重要意义。
Objective:To investigate the correlation between plasma fibrinogen level and the incidence of sudden hearing loss.Method:A total of 225 patients(age ranging from 18 to 70 years)with sudden sensorineural hearing loss(SSNHL)were selected.The disease onset was within 2 weeks.No patient received previous medical intervention.Depending on the types of auditory threshold curve,SSNHL was divided into low frequency descending type,high frequency descending type,flat desending type and total deafness type.Two hundred and twentynine cases with normal hearing and no inflammatory diseases in the same period was selected as control group.Fibrinogen level and Blood Routine Indexes were detected for the purpose of retrospective cohort study.Result:The levels of fibrinogen in SSNHL group(2.98±0.59)g/L were significantly higher than that in control group(2.66±0.36)g/L(P<0.001).According to the types of auditory threshold curve,SSNHL groups were divided into group A(55 cases,24.44%),Group B(36 cases,16.00%),Group C(43 cases,19.11%)and Group D(91 cases,40.44%).The average fibrinogen levels before treatment were at(2.75±0.46)g/L,(3.16±0.61)g/L,(3.02±0.63)g/L and(3.03±0.63)g/L respectively.There was no significant difference in fibrinogen level(P=0.286)between group A and the control group.Fibrinogen levels of group B,group C and group D were significantly elevated compared to control group(P<0.001).Conclusion:The level of fibrinogen is not significantly correlated with development of sudden deafness of low frequency descending type.The incidence of high frequency descending type,flat descending type and profound deafness type are all correlated with the level of high fibrinogen at the onset of sudden deafness.The classification of sudden deafness based on audiogram curves could be of great significance for analysis of possible causes and selection of treatment options.
Objective:To investigate the correlation between plasma fibrinogen level and the incidence of sudden hearing loss.Method:A total of 225 patients(age ranging from 18 to 70 years)with sudden sensorineural hearing loss(SSNHL)were selected.The disease onset was within 2 weeks.No patient received previous medical intervention.Depending on the types of auditory threshold curve,SSNHL was divided into low frequency descending type,high frequency descending type,flat desending type and total deafness type.Two hundred and twentynine cases with normal hearing and no inflammatory diseases in the same period was selected as control group.Fibrinogen level and Blood Routine Indexes were detected for the purpose of retrospective cohort study.Result:The levels of fibrinogen in SSNHL group(2.98±0.59)g/L were significantly higher than that in control group(2.66±0.36)g/L(P<0.001).According to the types of auditory threshold curve,SSNHL groups were divided into group A(55 cases,24.44%),Group B(36 cases,16.00%),Group C(43 cases,19.11%)and Group D(91 cases,40.44%).The average fibrinogen levels before treatment were at(2.75±0.46)g/L,(3.16±0.61)g/L,(3.02±0.63)g/L and(3.03±0.63)g/L respectively.There was no significant difference in fibrinogen level(P=0.286)between group A and the control group.Fibrinogen levels of group B,group C and group D were significantly elevated compared to control group(P<0.001).Conclusion:The level of fibrinogen is not significantly correlated with development of sudden deafness of low frequency descending type.The incidence of high frequency descending type,flat descending type and profound deafness type are all correlated with the level of high fibrinogen at the onset of sudden deafness.The classification of sudden deafness based on audiogram curves could be of great significance for analysis of possible causes and selection of treatment options.
引文
[1]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.突发性聋诊断和治疗指南(2015)[J].中华耳鼻咽喉头颈外科杂志,2015,50(6):443-447.
[2]STACHLER R J,CHANDRASEKHAR S S,ARCH-ER S M,et al.Clinical practice guideline:sudden hearing loss[J].Otolaryngol Head Neck Surg,2012,146(3Suppl):S1-35.
[3]WEI B P,STATHOPOULOS D,O'LEARY S.Steroids for idiopathic sudden sensorineural hearing loss[J].Cochrane Database Syst Rev,2013,7:CD003998.
[4]SCHREIBER B E,AGRUP C,HASKARD D O,et al.Sudden sensorineural hearing loss[J].Lancet,2010,375:1203-1211.
[5]RAUCH S D.Clinical practice.Idiopathic sudden sensorineural hearing loss[J].N Engl J Med,2008,359:833-840.
[6]杨剑,刘博,韩德民.突发性耳聋的循环病因机制[J].国际耳鼻咽喉头颈外科杂志,2006,30(3):175-177.
[7]MICHEL O,DEUTSCHE GESELLSCHAFT FüRHALS-NASEN-OHREN-HEILKUNDE,KOPF-UND HALS-CHIRURGIE.The revised version of the german guidelines"sudden idiopathic sensorineural hearing loss"[J].Laryngorhinootologie,2011,90:290-293.
[8]PLONTKE S K.Diagnostics and Therapy of Idiopathic Sudden Sensorineural Hearing LOSS[J].Laryngorhinootologie,2017,96:S103-S122.
[9]APPIAH D,SCHREINER P J,MACLEHOSE R F,et al.Association of Plasmaγ'Fibrinogen With Incident Cardiovascular Disease:The Atherosclerosis Risk in Communities(ARIC)Study[J].Arterioscler Thromb Vasc Biol,2015,35:2700-2706.
[10]STEC J J,SILBERSHATZ H,TOFLER G H,et al.Association of fibrinogen with cardiovascular risk factors and cardiovascular disease in the Framingham Offspring Population[J].Circulation,2000,102:1634-1638.
[11]FIBRINOGEN STUDIES COLLABORATION,DANESH J,LEWINGTON S,et al.Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality:an individual participant metaanalysis[J].JAMA,2005,294:1799-1809.
[12]OYA R,HORII A,AKAZAWA H,et al.Prognostic predictors of sudden sensorineural hearing loss in defibrinogenation therapy[J].Acta Otolaryngol,2016,136:271-276.
[13]KANZAKI S,SAKAGAMI M,HOSOI H,et al.High fibrinogen in peripheral blood correlates with poorer hearing recovery in idiopathic sudden sensorineural hearing loss[J].PLoS One,2014,9:e104680.
[14]NAKASHIMA T,NAGANAWA S,SONE M,et al.Disorders of cochlear blood flow[J].Brain Res Brain Res Rev,2003,43:17-28.
[15]ETSCHEID M,SUBRAMANIAM S,LOCHNIT G,et al.Altered structure and function of fibrinogen after cleavage by Factor VII Activating Protease(FSAP)[J].Biochim Biophys Acta Mol Basis Dis,2018,1864:3397-3406.
[16]陈桂珍,何彦林.人纤维蛋白原的研究进展[J].国际检验医学杂志,2004,36(6):503-505.
[17]陆良钧,钟志生,于银坤,等.纤维蛋白原水平与突发性聋发病的关联性研究[J].临床耳鼻咽喉头颈外科杂志,2008,22(1):8-13.
[18]XU X,TENG X.Effect of fibrinogen on blood coagulation detected by optical coherence tomography[J].Phys Med Biol,2015,60:4185-4195.
[19]中国突发性聋多中心临床研究协作组.中国突发性聋分型治疗的多中心临床研究[J].中华耳鼻咽喉头颈外科杂志,2013,48(5):355-361.
[20]张靖华,吴丽萍,陈英武,等.巴曲酶敏感程度与全频下降型突发性聋预后的相关性[J].实用医学杂志,2017,33(11):1854-1856.
[2]STACHLER R J,CHANDRASEKHAR S S,ARCH-ER S M,et al.Clinical practice guideline:sudden hearing loss[J].Otolaryngol Head Neck Surg,2012,146(3Suppl):S1-35.
[3]WEI B P,STATHOPOULOS D,O'LEARY S.Steroids for idiopathic sudden sensorineural hearing loss[J].Cochrane Database Syst Rev,2013,7:CD003998.
[4]SCHREIBER B E,AGRUP C,HASKARD D O,et al.Sudden sensorineural hearing loss[J].Lancet,2010,375:1203-1211.
[5]RAUCH S D.Clinical practice.Idiopathic sudden sensorineural hearing loss[J].N Engl J Med,2008,359:833-840.
[6]杨剑,刘博,韩德民.突发性耳聋的循环病因机制[J].国际耳鼻咽喉头颈外科杂志,2006,30(3):175-177.
[7]MICHEL O,DEUTSCHE GESELLSCHAFT FüRHALS-NASEN-OHREN-HEILKUNDE,KOPF-UND HALS-CHIRURGIE.The revised version of the german guidelines"sudden idiopathic sensorineural hearing loss"[J].Laryngorhinootologie,2011,90:290-293.
[8]PLONTKE S K.Diagnostics and Therapy of Idiopathic Sudden Sensorineural Hearing LOSS[J].Laryngorhinootologie,2017,96:S103-S122.
[9]APPIAH D,SCHREINER P J,MACLEHOSE R F,et al.Association of Plasmaγ'Fibrinogen With Incident Cardiovascular Disease:The Atherosclerosis Risk in Communities(ARIC)Study[J].Arterioscler Thromb Vasc Biol,2015,35:2700-2706.
[10]STEC J J,SILBERSHATZ H,TOFLER G H,et al.Association of fibrinogen with cardiovascular risk factors and cardiovascular disease in the Framingham Offspring Population[J].Circulation,2000,102:1634-1638.
[11]FIBRINOGEN STUDIES COLLABORATION,DANESH J,LEWINGTON S,et al.Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality:an individual participant metaanalysis[J].JAMA,2005,294:1799-1809.
[12]OYA R,HORII A,AKAZAWA H,et al.Prognostic predictors of sudden sensorineural hearing loss in defibrinogenation therapy[J].Acta Otolaryngol,2016,136:271-276.
[13]KANZAKI S,SAKAGAMI M,HOSOI H,et al.High fibrinogen in peripheral blood correlates with poorer hearing recovery in idiopathic sudden sensorineural hearing loss[J].PLoS One,2014,9:e104680.
[14]NAKASHIMA T,NAGANAWA S,SONE M,et al.Disorders of cochlear blood flow[J].Brain Res Brain Res Rev,2003,43:17-28.
[15]ETSCHEID M,SUBRAMANIAM S,LOCHNIT G,et al.Altered structure and function of fibrinogen after cleavage by Factor VII Activating Protease(FSAP)[J].Biochim Biophys Acta Mol Basis Dis,2018,1864:3397-3406.
[16]陈桂珍,何彦林.人纤维蛋白原的研究进展[J].国际检验医学杂志,2004,36(6):503-505.
[17]陆良钧,钟志生,于银坤,等.纤维蛋白原水平与突发性聋发病的关联性研究[J].临床耳鼻咽喉头颈外科杂志,2008,22(1):8-13.
[18]XU X,TENG X.Effect of fibrinogen on blood coagulation detected by optical coherence tomography[J].Phys Med Biol,2015,60:4185-4195.
[19]中国突发性聋多中心临床研究协作组.中国突发性聋分型治疗的多中心临床研究[J].中华耳鼻咽喉头颈外科杂志,2013,48(5):355-361.
[20]张靖华,吴丽萍,陈英武,等.巴曲酶敏感程度与全频下降型突发性聋预后的相关性[J].实用医学杂志,2017,33(11):1854-1856.