血清总胆固醇水平对全聋型突发性耳聋预后影响的前瞻性队列研究
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摘要
目的探讨血清总胆固醇对全聋型突发性耳聋患者的预后影响,为临床治疗和预后评估提供依据。方法采用前瞻性队列研究设计方法,纳入2015年6月至2017年3月温州市中心医院确诊的全聋型突发性耳聋患者,收集其年龄、性别、高血压、糖尿病、眩晕、总胆固醇(TC)水平、甘油三酯(TG)水平、低密度脂蛋白(LDL-C)水平等资料。采用单因素和多因素Logistic回归方法分析TC水平对全聋型突发性耳聋预后的影响。结果 TC水平5.2 mmol/L~6.2 mmol/L时的患者治疗有效率高于TC水平<5.2 mmol/L的患者[单因素:RR=6.49,95%CI(3.16,13.30),P<0.001;多因素:RR=6.15,95%CI(2.66,14.3),P<0.001]。TC水平>6.2 mmol/L治疗有效率与TC水平<5.2 mmol/L的患者差异无统计学意义[单因素:RR=1.02,95%CI(0.52,2.00),P=0.960;多因素:RR=1.61,95%CI(0.55,4.73),P=0.386]。按性别进行亚组分析发现,无论男性和女性患者,TC水平5.2 mmol/L~6.2 mmol/L的治疗有效率均高于TC水平<5.2 mmol/L的患者,TC水平>6.2 mmol/L和TC水平<5.2 mmol/L的患者差异均无统计学意义(P值均>0.05)。结论本研究结果显示TC水平介于5.2 mmol/L~6.2 mmol/L时患者的预后最优。
Objectives To investigate the correlation between blood total cholesterol(TC) and prognosis of idiopathic sudden sensorineural hearing loss(ISSNHL) and to provide references for clinical treatment and prognosis assessment.Methods We included 232 ISSNHL patients with total deafness in Wenzhou Central Hospital from June2015 to March 2017 using a prospective cohort design.Recording information including age,gender,hypertension,diabetes mellitus,vertigo,level of blood total cholesterol(TC),level of triglyceride(TG),level of low-density lipoprotein(LDL-C) and LDL/HDL ratio(LDL-C/HDL-C) were collected.Correlation between the prognosis of ISSNHL and blood total cholesterol were analyzed by univariable and multivariable logistic regression analysis.Results The clinical effective rate of patients with TC ranging from 5.2 mmol/L to 6.2 mmol/L was higher than that of patients with TC lower than 5.2 mmol/L(univariable:RR=6.49,95%CI 3.16 to 13.30,P<0.001;multivariable-adjusted covariates:RR=6.15,95%CI 2.66 to14.3,P<0.001) with significant difference.No significant difference was found between patients with TC lower than 5.2 mmol/L and patients with TC higher than 6.2 mmol/L(univariable:RR=1.02,95%CI 0.52 to 2.00,P=0.960;multivariable-adjusted covariates:RR=1.61,95%CI 0.55 to 4.73,P=0.386).Gender-specific analysis showed for both male and female groups,the effective rates of patients with TC ranging from 5.2 mmol/L to 6.2 mmol/L were significantly higher than those of patients with TC lower than 5.2 mmol/L.There was no significant difference between patients with TC lower than 5.2 mmol/L and patients with TC higher than 6.2 mmol/L(P>0.05) in either male group or female group.Conclusion The current study suggests that patients with levels of TC ranging from 5.2 mmol/L to 6.2 mmol/L predicts the best prognosis.
Objectives To investigate the correlation between blood total cholesterol(TC) and prognosis of idiopathic sudden sensorineural hearing loss(ISSNHL) and to provide references for clinical treatment and prognosis assessment.Methods We included 232 ISSNHL patients with total deafness in Wenzhou Central Hospital from June2015 to March 2017 using a prospective cohort design.Recording information including age,gender,hypertension,diabetes mellitus,vertigo,level of blood total cholesterol(TC),level of triglyceride(TG),level of low-density lipoprotein(LDL-C) and LDL/HDL ratio(LDL-C/HDL-C) were collected.Correlation between the prognosis of ISSNHL and blood total cholesterol were analyzed by univariable and multivariable logistic regression analysis.Results The clinical effective rate of patients with TC ranging from 5.2 mmol/L to 6.2 mmol/L was higher than that of patients with TC lower than 5.2 mmol/L(univariable:RR=6.49,95%CI 3.16 to 13.30,P<0.001;multivariable-adjusted covariates:RR=6.15,95%CI 2.66 to14.3,P<0.001) with significant difference.No significant difference was found between patients with TC lower than 5.2 mmol/L and patients with TC higher than 6.2 mmol/L(univariable:RR=1.02,95%CI 0.52 to 2.00,P=0.960;multivariable-adjusted covariates:RR=1.61,95%CI 0.55 to 4.73,P=0.386).Gender-specific analysis showed for both male and female groups,the effective rates of patients with TC ranging from 5.2 mmol/L to 6.2 mmol/L were significantly higher than those of patients with TC lower than 5.2 mmol/L.There was no significant difference between patients with TC lower than 5.2 mmol/L and patients with TC higher than 6.2 mmol/L(P>0.05) in either male group or female group.Conclusion The current study suggests that patients with levels of TC ranging from 5.2 mmol/L to 6.2 mmol/L predicts the best prognosis.
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.突发性耳聋诊断和治疗指南(2015).中华耳鼻咽喉头颈外科杂志,2015,50(6):443-447.
2Lawrence R,Thevasagayam R.Controversies in the management of sudden sensorineural hearing loss:an evidence-based review.Clin Otolaryngol,2015,40(3):176-182.
3Muhlmeier G,Baguley D,Cox T,et al.Characteristics and spontaneous recovery of tinnitus related to idiopathic sudden sensorineural hearing loss.Otol Neurotol,2016,37(6):634-641.
4Nogueira-Neto FB,Gallardo FP,Suzuki FA,et al.Prognostic and evolutive factors of tinnitus triggered by sudden sensorineural hearing loss.Otol Neurotol,2016,37(6):627-633.
5Kim CH,Shin JE,Yang YS,et al.Sudden sensorineural hearing loss with positional vertigo:Initial findings of positional nystagmus and hearing outcomes.Int J Audiol,2016,55(10):541-546.
6Lionello M,Staffieri C,Breda S,et al.Uni-and multivariate models for investigating potential prognostic factors in idiopathic sudden sensorineural hearing loss.Eur Arch Otorhinolaryngol,2015,272(8):1899-1906.
7Kang WS,Yang CJ,Shim M,et al.Prognostic factors for recovery from sudden sensorineural hearing loss:a retrospective study.J Audiol Otol,2017,21(1):9-15.
8Quaranta N,Squeo V,Sangineto M,et al.High total cholesterol in peripheral blood correlates with poorer hearing recovery in idiopathic sudden sensorineural hearing loss.PLo S One,2015,10 (7):e0133300.
9Lin CF,Lee KJ,Yu SS,et al.Effect of comorbid diabetes and hypercholesterolemia on the prognosis of idiopathic sudden sensorineural hearing loss.Laryngoscope,2016,126(1):142-149.
10中国胆固醇教育计划委员会.高甘油三酯血症及心血管危险因素管理共识.中华心血管病杂志,2017,42(2):108-115.
11Mohammed AA.Lipid profile among patients with sudden sensorineural hearing loss.Indian J Otolaryngol Head Neck Surg,2014,66(4):425-428.
12Lee JS,Kim DH,Lee HJ,et al.Lipid profiles and obesity as potential risk factors of sudden sensorineural hearing loss.PLo S One,2015,10(4):e0122496.
13Weng T,Devine EE,Xu H,et al.A clinical study of serum lipid disturbance in Chinese patients with sudden deafness.Lipids Health Dis,2013,12:95.
14Lin HC,Wang CH,Chou YC,et al.The correlation between lipoprotein ratios and hearing outcome in idiopathic sudden sensorineural hearing loss patients.Clin Otolaryngol,2015,40(4):355-362.
15Chang IJ,Kang CJ,Yueh CY,et al.The relationship between serum lipids and sudden sensorineural hearing loss:a systematic review and meta-analysis.PLo S One,2015,10(4):e0121025.
16Expert panel on detection,evaluation,and treatment of high blood cholesterol in adults.Executive summary of the third report of the national cholesterol education program(NCEP)Expert panel on detection,evaluation,and treatment of high blood cholesterol in adults(Adult Treatment Panel III).JAMA,2001,285(19):2486-2497.
17许汝福.Logistic回归变量筛选及回归方法选择实例分析.中国循证医学杂志,2016,16(11):1360-1364.
18田景平,温泽淮,郭新峰,等.脂必泰与阿托伐他汀比较治疗高脂血症疗效及安全性的系统评价.中国循证医学杂志,2013,13(9):1116-1122.
19赵水平,谢琼.动脉粥样硬化发病机制新认识与临床实践.中华心血管病杂志,2008,36(8):766-768.
20孙鑫,谭婧,唐立,等.重新认识真实世界研究.中国循证医学杂志,2017,17(2):126-130.
2Lawrence R,Thevasagayam R.Controversies in the management of sudden sensorineural hearing loss:an evidence-based review.Clin Otolaryngol,2015,40(3):176-182.
3Muhlmeier G,Baguley D,Cox T,et al.Characteristics and spontaneous recovery of tinnitus related to idiopathic sudden sensorineural hearing loss.Otol Neurotol,2016,37(6):634-641.
4Nogueira-Neto FB,Gallardo FP,Suzuki FA,et al.Prognostic and evolutive factors of tinnitus triggered by sudden sensorineural hearing loss.Otol Neurotol,2016,37(6):627-633.
5Kim CH,Shin JE,Yang YS,et al.Sudden sensorineural hearing loss with positional vertigo:Initial findings of positional nystagmus and hearing outcomes.Int J Audiol,2016,55(10):541-546.
6Lionello M,Staffieri C,Breda S,et al.Uni-and multivariate models for investigating potential prognostic factors in idiopathic sudden sensorineural hearing loss.Eur Arch Otorhinolaryngol,2015,272(8):1899-1906.
7Kang WS,Yang CJ,Shim M,et al.Prognostic factors for recovery from sudden sensorineural hearing loss:a retrospective study.J Audiol Otol,2017,21(1):9-15.
8Quaranta N,Squeo V,Sangineto M,et al.High total cholesterol in peripheral blood correlates with poorer hearing recovery in idiopathic sudden sensorineural hearing loss.PLo S One,2015,10 (7):e0133300.
9Lin CF,Lee KJ,Yu SS,et al.Effect of comorbid diabetes and hypercholesterolemia on the prognosis of idiopathic sudden sensorineural hearing loss.Laryngoscope,2016,126(1):142-149.
10中国胆固醇教育计划委员会.高甘油三酯血症及心血管危险因素管理共识.中华心血管病杂志,2017,42(2):108-115.
11Mohammed AA.Lipid profile among patients with sudden sensorineural hearing loss.Indian J Otolaryngol Head Neck Surg,2014,66(4):425-428.
12Lee JS,Kim DH,Lee HJ,et al.Lipid profiles and obesity as potential risk factors of sudden sensorineural hearing loss.PLo S One,2015,10(4):e0122496.
13Weng T,Devine EE,Xu H,et al.A clinical study of serum lipid disturbance in Chinese patients with sudden deafness.Lipids Health Dis,2013,12:95.
14Lin HC,Wang CH,Chou YC,et al.The correlation between lipoprotein ratios and hearing outcome in idiopathic sudden sensorineural hearing loss patients.Clin Otolaryngol,2015,40(4):355-362.
15Chang IJ,Kang CJ,Yueh CY,et al.The relationship between serum lipids and sudden sensorineural hearing loss:a systematic review and meta-analysis.PLo S One,2015,10(4):e0121025.
16Expert panel on detection,evaluation,and treatment of high blood cholesterol in adults.Executive summary of the third report of the national cholesterol education program(NCEP)Expert panel on detection,evaluation,and treatment of high blood cholesterol in adults(Adult Treatment Panel III).JAMA,2001,285(19):2486-2497.
17许汝福.Logistic回归变量筛选及回归方法选择实例分析.中国循证医学杂志,2016,16(11):1360-1364.
18田景平,温泽淮,郭新峰,等.脂必泰与阿托伐他汀比较治疗高脂血症疗效及安全性的系统评价.中国循证医学杂志,2013,13(9):1116-1122.
19赵水平,谢琼.动脉粥样硬化发病机制新认识与临床实践.中华心血管病杂志,2008,36(8):766-768.
20孙鑫,谭婧,唐立,等.重新认识真实世界研究.中国循证医学杂志,2017,17(2):126-130.