2型糖尿病患者听觉阈值与周围神经病变的关系分析

Relationship between hearing threshold and peripheral neuropathy in type 2 diabetic patients

目的通过比较无糖尿病的人群和2型糖尿病患者的纯音听阈值、振动觉阈值（VPT），了解2型糖尿病患者周围神经病变（DPN）与耳聋的关系。方法测定173例研究对象的VP11及纯音听阈值，2型糖尿病患者同时测定感觉神经传导速度（SCV）和运动神经传导速度（MCV），将其分为对照组35例，无糖尿病神经病变组74例，糖尿病伴神经病变组64例。比较3组的基本情况、感音神经性耳聋（SNHL）发生率、纯音听阈值和VPT值，分析听闽值和神经传导速度的关系。结果伴神经病变的糖尿病组SNHL发生率为29．69％，明显高于无糖尿病神经病变组（17．57％）和对照组（17．14％），且3组的年龄、糖尿病病程、HbA1c糖化血清蛋白（GA）、空腹血糖、餐后2h血糖、VPT和听阈值之间有显著性差异（均P〈0．05）。不同VPT亚组的听阈值之间也存在明显差异（均P〈0．05）。正中神经传导速度与1．00、2．00、4．00、8．00kHz听阈值呈明显负相关，logistic回归分析显示，年龄（回归系数=0．088，P〈0．01）是SNHL的独立危险因素，正中神经MCV（回归系数=-0．135，P=0．046）是影响SNHL的重要因素。结论糖尿病患者易影响中高频听力，DPN患者常同时合并听力受损，年龄、正中神经MCV是影响SNHL的主要危险因素。

Objective In order to investigate the relationship between hearing loss and diabetic peripheral neuropathy（DPN） via comparing the pure tone thresholds and vibration perception threshold（VPT） in type 2 diabetic patients and control person without diabetes. Methods 173 subjects including 138 type 2 diabetic patients （ DM ） and 35 non-diabetes controls were examined for VPT and hearing threshold. Nerve conducting velocity （ NCV ） including sensory nerve conducting velocity （SCV） and motorial nerve conducting velocity （MCV） of diabetic patients were determined. The participants were divided into three groups ： control group （ n = 35 ） , DM group without peripheral neuropathy（ non-PN group, n = 74 ） , and DM group complicated with peripheral neuropathy （ PN group, n =64）. The clinical characteristics, biochemical parameters , the incidence of sensorineural hearing loss（ SNHL）, pure tone threshold, and VPT were compared among three groups. At last, the relationship between heating thresholds and NCV were analyzed. Results The incidence of hearing impairment of sensorineural type was 29. 69% in PN group, which was significantly higher than that of non-PN group（ 17.57% ） and control group（ 17.14% ）. There was significant differences in age, duration of diabetes, glycolated hemoglobin （ HbA1c ）, glyeolated serum albumin （ GA）, Fasting blood glucose（ FPG）, 2h postprandial blood glucose（ PPG）, VPT, and hearing threshold among the three groups （ all P〈0. 05 ）. The value of hearing threshold increased significantly （ all P〈0. 05 ） in 3 VPT subgroups with VPT≤ 15 V, VPT 16-25 V, and VPT 〉25 V. The Spearman correlation analysis showed median NCV was negatively correlated with hearing threshold on 1.00, 2. 00, 4.00, and 8.00 kHz （ All P 〈 0.05 ）. The logistic regression analysis indicated that the age（ regression coefficient =0. 088, P〈0. 01 ） was the independent risk factor of SNHL, median nerve MCV （regression coefficient =- 0. 135, P = 0. 046 ）was the important influencing factor of SNHL. Conclusion Diabetic patients are more likely to suffer from impaired middle-frequency and high-frequency hearing, DPN in patients is often complicated with hearing impairment. Age and median nerve MCV were major risk factors of SNHL in diabetic patients.