突发性聋患者外周血炎症因子的相关研究
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摘要
目的:通过比较突发性聋(突聋)患者与正常人外周血炎症因子水平,探讨炎症因子在突聋发生发展中的作用及对突聋患者听力恢复的预测价值。方法:收集因突聋就诊住院的患者72例和正常人19例。治疗开始前行电测听检查,抽取外周血行血常规检查,并用ELISA法检测外周血中IL-1β、IL-6、IL-17α、TGF-β1及TNF-α炎症因子水平。采用的治疗方案为激素静脉滴注(无全身激素应用禁忌)+鼓室内激素注射+改善微循环和(或)营养神经治疗+高压氧。治疗结束后再行电测听检查,经患者知情同意,其中26例患者治疗结束时再次抽取外周血检测炎症因子水平。结果:突聋患者外周血炎症因子IL-1β、IL-6、IL-17α、TGF-β1、TNF-α平均水平分别为(2.66±9.57)pg/ml,(4.71±6.91)pg/ml,(19.33±32.27)pg/ml,(50 018.37±14 660.72)pg/ml,(1.52±2.40)pg/ml,正常人外周血炎症因子平均水平分别为(3.61±9.82)pg/ml,(3.58±4.49)pg/ml,(11.64±13.29)pg/ml,(45 199.98±11 956.09)pg/ml,(1.09±1.08)pg/ml,2组间外周血各炎性因子水平差异无统计学意义。治疗有效(听力阈值提高≥15dB)45例,无效(听力阈值提高<15dB)27例,2组炎症因子水平差异无统计学意义。其中有治疗前后血标本的26例患者中,TGF-β1治疗后水平较治疗前TGF-β1水平有显著性下降。结论:外周血炎症因子IL-1β、IL-6、IL-17α、TGF-β1、TNF-α的水平不能预测突聋听力恢复情况,炎症反应在突聋发生发展中的作用有待进一步证实。其中炎症因子TGF-β1可能参与突聋的发生发展过程。
Objective:The aim of this study is to compare the difference of inflammatory factors in peripheral blood between sudden deafness patients and normal people,and to evaluate the predictive value of inflammatory factors in hearing recovery of sudden deafness patients.Method:Seventy-two inpatients with sudden deafness and19 healthy persons were included.At the beginning of treatment in our hospital,audiometry was performed and peripheral blood was collected.The levels of IL-1β,IL-6,IL-17α,TGF-β1 and TNF-αin peripheral blood were detected by ELISA.The treatment was intravenous steroid(not applied if patients with contraindication of systemic steroid application)+intratympanic steroid injection+ microcirculation improvement or neurotrophic therapy+hyperbaric oxygen.At the end of the treatment,audiometry was performed again.A total of 26 patients were collected to test the levels of inflammatory factors in peripheral blood again at the end of the treatment.Result:The mean levels of inflammatory factors IL-1β,IL-6,IL-17α,TGF-β1 and TNF-αin peripheral blood of patients were(2.66±9.57)pg/ml,(4.71±6.91)pg/ml,(19.33±32.27)pg/ml,(50 018.37±14 660.72)pg/ml,(1.52±2.40)pg/ml,respectively.And the level of these five inflammatory factors in normal persons were(3.61±9.82)pg/ml,(3.58±4.49)pg/ml,(11.64±13.29)pg/ml,(45 199.98±11 956.09)pg/ml,(1.09±1.08)pg/ml respectively.Statistical analysis showed no significant difference between these two groups.A total of 45 cases were effective(hearing threshold increased≥15 dB)and 27 cases were ineffective(hearing threshold increased<15 dB).There was no significant difference in the levels of inflammatory factors between the two groups.Among 26 patients with blood samples before and after treatment,the level of TGF-β1 after treatment was significantly lower than that before treatment.Conclusion:The levels of these five inflammatory factors including IL-1β,IL-6,IL-17α,TGF-β1 and TNF-αin peripheral blood could not predict the recovery of sudden hearing loss.The role of inflammation in the development of sudden deafness needs further confirmation.TGF-β1 may be involved in the development of sudden deafness.
Objective:The aim of this study is to compare the difference of inflammatory factors in peripheral blood between sudden deafness patients and normal people,and to evaluate the predictive value of inflammatory factors in hearing recovery of sudden deafness patients.Method:Seventy-two inpatients with sudden deafness and19 healthy persons were included.At the beginning of treatment in our hospital,audiometry was performed and peripheral blood was collected.The levels of IL-1β,IL-6,IL-17α,TGF-β1 and TNF-αin peripheral blood were detected by ELISA.The treatment was intravenous steroid(not applied if patients with contraindication of systemic steroid application)+intratympanic steroid injection+ microcirculation improvement or neurotrophic therapy+hyperbaric oxygen.At the end of the treatment,audiometry was performed again.A total of 26 patients were collected to test the levels of inflammatory factors in peripheral blood again at the end of the treatment.Result:The mean levels of inflammatory factors IL-1β,IL-6,IL-17α,TGF-β1 and TNF-αin peripheral blood of patients were(2.66±9.57)pg/ml,(4.71±6.91)pg/ml,(19.33±32.27)pg/ml,(50 018.37±14 660.72)pg/ml,(1.52±2.40)pg/ml,respectively.And the level of these five inflammatory factors in normal persons were(3.61±9.82)pg/ml,(3.58±4.49)pg/ml,(11.64±13.29)pg/ml,(45 199.98±11 956.09)pg/ml,(1.09±1.08)pg/ml respectively.Statistical analysis showed no significant difference between these two groups.A total of 45 cases were effective(hearing threshold increased≥15 dB)and 27 cases were ineffective(hearing threshold increased<15 dB).There was no significant difference in the levels of inflammatory factors between the two groups.Among 26 patients with blood samples before and after treatment,the level of TGF-β1 after treatment was significantly lower than that before treatment.Conclusion:The levels of these five inflammatory factors including IL-1β,IL-6,IL-17α,TGF-β1 and TNF-αin peripheral blood could not predict the recovery of sudden hearing loss.The role of inflammation in the development of sudden deafness needs further confirmation.TGF-β1 may be involved in the development of sudden deafness.
引文
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[12]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.突发性聋的诊断和治疗指南(2015年)[J].中华耳鼻咽喉头颈外科杂志,2015,50(6):443-446.
[13]MASUDA M,KANZAKI S,MINAMI S,et al.Correlations of Inflammatory Biomarkers With the Onset and Prognosis of Idiopathic Sudden Sensorineural Hearing Loss[J].Otol Neurotol,2012,33:1142-1150.
[14]ULU S,ULU M S,BUCAK A,et al.Neutrophil-tolymphocyte ratio as a new,quick,and reliable indicator for predicting diagnosis and prognosis of idiopathic sudden sensorineural hearing loss[J].Otol Neurotol,2013,34:1400-1404.
[15]FUJIOKA M,KANZAKI S,OKANO H J,et al.Proinflammatory cytokines expression in noise-induced damaged cochlea[J].J Neurosci Res,2006,83:575-583.
[16]STOKROOS R J,ALBERS F W,KRIKKE A P,et al.Magnetic Resonance Imaging of the Inner Ear in Patients with Idiopathic Sudden Sensorineural Hearing Loss[J].Eur Arch Otorhinolaryngol,1998,255:433-436.
[17]VETHANAYAGAM R R,YANG W,DONG Y,et al.Toll-like Receptor 4 Modulates the Cochlear Immune Response to Acoustic Injury[J].Cell Death Dis,2016,7:e2245.
[2]FU Y,ZHAO H,ZHANG T,et al.Intratympanic dexamethasone as initial therapy for idiopathic sudden sensorineural hearing loss:clinical evaluation and laboratory investigation[J].Auris Nasus Larynx,2011,38:165-171.
[3]FUKUDA S,CHIDA E,KURODA T,et al.An antimumps IgM antibody level in the serum of idiopathic sudden sensorineural hearing loss[J].Auris Nasus Larynx,2001,28Suppl:S3-5.
[4]WILSON W R.The relationship of the herpesvirus family to sudden hearing loss:aprospective clinical study and literature review[J].Laryngoscope,1986,96:870-877.
[5]KOIDE J,YANAGITA N,HONDO R,et al.Serological and clinical study of herpes simplex virusinfection in patients with sudden deafness[J].Acta Otolaryngol Suppl,1988,456:21-26.
[6]FUKUDA S,FURUTA Y,TAKASU T,et al.The significance of herpes viral latency in the spiral ganglia[J].Acta Otolaryngol Suppl,1994,514:108-110.
[7]TAKASAKI T,HIGASHIKAWA M,MOTOYAMAS,et al.Serum antibodies to humanherpesvirus 7,human herpesvirus 6and cytomegalovirus in patients with idiopathic facial nerve palsyor sudden deafness[J].J Laryngol Otol,1998,112:617-621.
[8]XENELLIS J,NIKOLOPOULOS T P,STAVROU-LAKI P,et al.Simultaneous and sequential bilateral sudden sensorineural hearing loss:are they different from unilateral sudden sensorineural hearing loss?[J].ORL J Otorhinolaryngol Relat Spec,2007,69:306-310.
[9]MENTEL R,KAFTAN H,WEGNER U,et al.Are enterovirus infections a co-factor in sudden hearing loss?[J].J Med Virol,2004,72:625-629.
[10]KIKIDIS D,NIKOLOPOULOS T P,KAMPESSISG,et al.Sudden sensorineural hearing loss:subclinical viral and toxoplasmosis infections as aetiology and how they alter the clinical course[J].ORL J Otorhinolaryngol Relat Spec,2011,73:110-115.
[11]MERCHANT S N,DURAND M L,ADAMS J C.Sudden deafness:is it viral?[J].ORL J Otorhinolaryngol Relat Spec,2008,70:52-60.
[12]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.突发性聋的诊断和治疗指南(2015年)[J].中华耳鼻咽喉头颈外科杂志,2015,50(6):443-446.
[13]MASUDA M,KANZAKI S,MINAMI S,et al.Correlations of Inflammatory Biomarkers With the Onset and Prognosis of Idiopathic Sudden Sensorineural Hearing Loss[J].Otol Neurotol,2012,33:1142-1150.
[14]ULU S,ULU M S,BUCAK A,et al.Neutrophil-tolymphocyte ratio as a new,quick,and reliable indicator for predicting diagnosis and prognosis of idiopathic sudden sensorineural hearing loss[J].Otol Neurotol,2013,34:1400-1404.
[15]FUJIOKA M,KANZAKI S,OKANO H J,et al.Proinflammatory cytokines expression in noise-induced damaged cochlea[J].J Neurosci Res,2006,83:575-583.
[16]STOKROOS R J,ALBERS F W,KRIKKE A P,et al.Magnetic Resonance Imaging of the Inner Ear in Patients with Idiopathic Sudden Sensorineural Hearing Loss[J].Eur Arch Otorhinolaryngol,1998,255:433-436.
[17]VETHANAYAGAM R R,YANG W,DONG Y,et al.Toll-like Receptor 4 Modulates the Cochlear Immune Response to Acoustic Injury[J].Cell Death Dis,2016,7:e2245.