突发性聋发病的免疫因素及激素治疗的疗效观察

Clinical observation of immunological function and effects of glucocorticoid in treatment of sudden deafness.

目的观察突发性聋患者的免疫功能状态,探讨突发性聋发病的免疫因素;在突发性聋治疗过程中,比较是否使用皮质类固醇,患者免疫功能变化和治疗效果。方法①采用流式细胞和免疫透射比浊法测定突聋患者外周血T细胞亚群及血清免疫球蛋白并与健康对照组比较;②患者随机分成两组,一组采取普通治疗(乙组),另一组(甲组)加用强的松,比较两组患者治疗后的细胞和体液免疫状态以及疗效。结果①90例突聋患者IgG、IgA、IgM、C3、C4浓度分别为(12.80±3.50)、(2.29±1.39)、(1.75±1.01)、(1.54±0.28)、(0.28±0.19),与健康对照组比有升高趋势,其中C3、IgG升高差异有统计学意义(P<0.05)。外周血T细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+分别为(62.08±5.01)、(39.92±4.30)、(29.03±7.04)、(1.52±0.65),其中CD4+、CD4+/CD8+降低差异有统计学意义(P<0.05)。②治疗后两组体液和细胞免疫各指标皆趋向正常,但甲组IgG下降、CD4+、CD4+/CD8+升高较乙组明显(P<0.05)。③非激素治疗组有效率为51.5%,激素组有效率为73.3%,两者差异有统计学意义(P<0.05)。结论突聋患者细胞免疫和体液免疫出现异常,表明突发性聋的发病与机体免疫状态密切相关,皮质类固醇激素的使用能改善患者的免疫状态,并显著提高疗效。

Objective To detect the immunological function in patients with sudden deafness and to find the relationship between sudden deafness and immune system;To observe the recovery rate of conventional therapy and steroid therapy.Methods ① The peripheral blood T lymphocyte subsets and the serum immunoglobulin of 90 patients with sudden deafness were detected by flow cytometry（FCM） and penetrologycal turbidimetry of immunology.The data were compared with the control of 90 cases.② 45 patients in one group were treated by conventional therapy and steroid therapy and 45 patients in another group were treated by conventional therapy only.After 15 days＇treatment,their immunological level and the average hearing loss were examined again.Results ① The serum immunoglobulins（IgA、IgG、IgM、C3、C4） of patients were（2.29±1.39）、（12.80±3.50）、（1.75±1.01）、（1.54±0.28）、（0.28±0.19）.Comparing with the control group,the increase of IgG、C3 were very significant（P0.05）.The T lymphocyte subset（CD3＋、CD4＋、CD8＋、CD4＋/CD8＋） of sudden deafness patients was（62.08±5.01）、（39.92±4.30）、（29.03±7.04）、（1.52±0.65）.CD4＋、CD4＋/CD8＋ levels of patients were lowered,compared to the control group（P0.05）.② After the treatment,only in the group treated by both conventional therapy and steroid therapy,there was a significant increase in the ratio of CD4＋、CD4＋/CD8＋ and a significant reduction in the IgG level.③ The patients treated by conventional therapy showed recovery rate was 51.5%.On the contrary,the rate in the patients treated by steroid and conventional therapy was 73.3%.The recovery rate was statistically significant（P0.05） between the two group.Conclusion The result indicates that immunity is an important role in the causation of SSNHL.The patients who used the steroid had a better effect in the immunization and treatment.