突发性耳聋患者中医辨证分型与纯音测听指标的对照

Dialectical types of traditional Chinese medicine and pure tone test indexes in patients with sudden hearing loss

目的:对突发性耳聋患者中医辨证分型与纯音测听指标进行对照,分析二者的关系及规律性。方法:选择2002-10/2005-10在沈阳医学院附属沈州医院门诊就诊和住院治疗的突发聋患者192例,入选病例均在治疗开始前由资深中医师进行辨证诊断,根据患者的病史和症状,以及舌象、临床表现,初步拟设风热侵袭型、肝火上扰型、痰火蕴结型、肾精亏损型、脾胃虚弱型和气滞血瘀型等6个基本证型。并接受了纯音听阈检查,纯音听阈检查使用MedseOB822听力计,采用上升法检查气、骨导纯音听阈。以4级分类法为标准:①轻度聋:纯音听力损失10～30dB;②中度聋:纯音听力损失31～60dB;③重度聋:纯音听力损失61～90dB;④极重度聋:纯音听力损失>90dB。听力损失损失图形按7种图形划分:①高频听力损失型。②低频听力损失型。③中频听力损失型。④碟型、平坦听力损失型。⑤岛状听力损失型。⑥高、低频听力损失型。⑦全频听力损失型。听力学检查时间为治疗前1周内。对不同中医证型突发聋患者纯音测听各项指标作一比较,进行归纳分析。结果:突发聋患者192例最终全部进入结果分析。①突发聋患者192例中,风热侵袭型47例,肝火上扰型28例,痰火蕴结型25例,肾精亏损型11例,脾胃虚弱型14例,气滞血瘀型67例。②与总体样本纯音测听指标比较中,痰火蕴结型、肾精亏损型、脾胃虚弱型和气滞血瘀型患者患耳多数纯音测听指标均明显高于总体样本,而风热侵袭型和肝火上扰型患者多数指标明显低于总体样本(P均<0.05～0.01)。③各组间比较中,痰火蕴结型、肾精亏损型、脾胃虚弱型和气滞血瘀型患者的双侧语音频率、8kHz频率多数测听指标均明显高于风热侵袭型和肝火上扰型患者,另有脾胃虚弱型双侧和气滞血瘀型患者的左侧4kHz频率明显高于后两者(P均<0.05～0.01)。④各证型突发聋患者听力损失程度比较中,风热侵袭型中轻度聋和中度聋较多见,而肝火上扰型则以中度聋居多数,痰火蕴结型、肾精亏损型、脾胃虚弱型和气滞血瘀型患者均以重度聋、极重度聋听力损失为主。⑤各证型患者听力损伤图形比较中,风热侵袭型和肝火上扰型损伤图形以高频听力损失型和碟型、平坦听力损失型为主,而痰火蕴结型仅以碟型、平坦听力损失型为多,气滞血瘀型以高频听力损失型、碟型平坦听力损失型和中频听力损失型为主要分布,肾精亏损型和脾胃虚弱型患者则以岛状听力损失型和全频听力损失型为主要代表。结论:各种中医证型突发聋患者听力损失程度、纯音听阈指标和听力损伤图形表现不一,痰火蕴结、肾精亏损、脾胃虚弱和气滞血瘀型患者听力损失程度较重,对各证型患者进行辨证施治有可能改善病情。

AIM： To investigate cross-check analysis between different dialectical types of traditional Chinese medicine （TCM） and pure tone test index of patients with sudden hearing loss to probe into their regularity. METHODS： A total of 192 in-patients or out-patients with sudden hearing loss were selected from Shenzhou Hospital of Shenyang Medical College between October 2002 and October 2005. All subjects were diagnosed by senior TCM physicians and received pure-tone audibility-threshold test. According to patients＇ history of disease, syndrome, tongue condition and clinical stituation, they were assigned into 6 basic types： wind-heat inva- sion, disturbing upward of llver-fire, pyrophlegm-stasis, damage of kidneyessence, weakness of the spleen and stomach; qi-stagnancy and blood stasis. In the pure-tone audibility-threshold test Medse OB822 acoutometer was applied. Qi and bone conduction pure-tone audibility-threshold was examined with elevating method. Taking 4-grade classification as criteria：①mild deafness： pure-tone hearing loss for 10-30 dB, ②moderate deaf- ness： pure-time hearing loss for 31-60 dB, ③severe deafness： pure-tone hearing loss for 61-90 dB, and ④extremely severe deafness： pure-tone hearing loss fbr more than 90 dB. On the basis of 7 kinds of figures hearing loss figure contained ①high frequency hearing loss, ②low frequency hearing loss, ③middle frequency hearing loss, ④saucer-like type, flat hearing loss type, ⑤island-like shape hearing loss type, ⑥high and low frequency hearing loss type, and ⑦full frequency hearing loss type. Audiology test duration was within 1 week before treatment. Each index of pure-tone audiometry in different dialectical types of TCM of patients with sudden hearing loss was compared, summarized and analyzed. RESULTS： A total of 192 patients with sudden heating loss were involved in the result analysis. ①The 192 patients with sudden heating less were distributed as. follow： 47 cases of wind-heat invasion, 28 cases of disturbing upward of liver-fire, 25 cases of pyrophlegm-stasis, 11 cases of damage of kidney-essence, 14 cases of weakness of the spleen and stomach, and 67 cases of qi-stagnancy and blood stasis. ②As compared with total samples of pure tone test, most indexes of patients in types of pyrophlegm-stasis, damage of kidney-essence, weakness of the spleen and stomach, and qi-stagnancy and blood stasis were markedly higher than those of total sampies; however, those of patients in types of wind-heat invasion and disturbing upward of liver-fire were obviously lower than those of total samples （P 〈 0.05-0.01）. ③Most indexes of bilateral voice frequencies and frequency at 8 kHz of patients in the types of pyrophlegm-stasis, damage of kidneyessence, weakness of the spleen and stomach and qi-stagnancy and blood stasis were remarkably higher than those of patients in the types of windheat invasion and disturbing upward of liver-fire. Moreover, bilateral frequencies of patients in the type of weakness of the spleen and stomach and left frequency at 4 kHz of patients in the type of qi-stagnancy and blood stasis were also dramatically higher than those of the latter two （P 〈 0.05 -0.01）. ④To compare degrees of hearing loss, degree of patients in type of wind-heat invasion was commonly moderate-mild and moderate; however, degree of patients in type of disturbing upward of liver-fire was moderate; degrees of patients in types of pyrophlegm-stasis, damage of kidney- essence, weakness of the spleen and stomach and qi-stagnancy and blood stasis were severe and greatly severe. ⑤To compare figures of heating loss, patients in types of wind-heat invasion and disturbing upward of liver-fire had high-frequent shape, saucer-like shape and flat shape; However, patients in the type of pyrophlegm-stasis had saucer-like shape and flat shape; patients in type of qi-stagnancy and blood stasis had high-frequent shape, saucer-like shape and moderate-frequent shape; patients in the types of damage of kidney-essence and weakness of the spleen and stomach had island-like shape and full frequent shape. CONCLUSION： Patients with sudden heating loss have different traditional types, such as degrees of hearing loss, pure-tone audibility-threshold index and figure of heating loss. Degrees of heating loss of patients in the types of pyrophlegrn-stasis, damage of kidney-essence, weakness of the spleen and stomach, and qi-stagnancy and blood stasis are severe. Dialectical treatments may improve patients＇ condition.