梅尼埃病耳蜗内淋巴积水程度与听力及其症状的相关性分析

The correlation of cochlea endolymphatic hydrops degree and hearing loss and symptoms in patients with Meniere＇s disease

目的探讨单侧梅尼埃病患者耳蜗内淋巴积水程度与听力及其临床症状的相关性。方法回顾性定量分析57例单侧梅尼埃患者的耳蜗内淋巴积水程度，并与患者听力及其临床症状进行相关性分析。以患侧耳为试验组（57只耳），对侧无症状耳为对照组（57只耳）。双侧耳均经鼓膜穿刺鼓室内注入Gd-DTPA稀释液，24h后行三维真实重建反转恢复（3DrealIR）序列MRI扫描，定量测量耳蜗底旋、中间旋、尖旋内淋巴间隙沿蜗轴及迷路腔沿蜗轴方向的最大径线，计算两者的比值（R）[底旋（R1）、中间旋（R2）、尖旋（R3）]。采用配对t检验比较试验组与对照组耳蜗内淋巴间隙程度的差异；Pearson检验分析患侧耳蜗内淋巴积水程度与听力、临床症状持续时间的相关性。结果患侧耳蜗R1、R2、R3分别为0．354±0．097、0．445±0．098、0．467±0．102，正常侧分别为0．185±0．031、0．201±0．046、0．221＋0．053，患侧各值均大于正常侧，差异均有统计学意义（f值分别为13．729、17．097、15．787，P值均〈0．01）。患侧耳蜗底旋、中间旋及尖旋的内淋巴积水程度均与高频听力有弱相关性（P值均〈0．05，r值分别为0．275、0．281、0．329），而与患者眩晕病程、每次眩晕持续时间、耳鸣时间及听力下降时间无相关性（P〉0．05）。此外，耳蜗尖旋的内淋巴积水程度与低频、中频、高频听力下降均有弱相关性（r值分别为0．271、0．269、0．329，P〈0．05）。结论耳蜗底旋、中间旋内淋巴积水程度与高频听力损失有相关性，尖旋内淋巴积水程度与低频、中频、高频听力损失均有相关性，而耳蜗内淋巴积水程度与年龄及其症状持续时间无明显相关性。

Objective To evaluate the correlation between the degree of cochlea endolymphatic hydrops （EH） and hearing loss and symptoms in patients with unilateral Meniere＇s disease. Methods Fifty seven patients with unilateral Meniere＇s patients were retrospectively quantitatively analyzed, which evaluated the correlation between the cochlea EH and hearing loss and symptoms. The affected ears in the experimental group （57 ears） and the asymptomatic ears in the control group （57 ears）, were confirmed by bilateral intratympanic Gd-DTPA injection and 3D real IR MRI scan after 24 h. The maximum length of endolymph space and labyrinth chamber along the modiolus cochleae and their ratio which represented the endolymph space proportion of each turn（R1, the basal turn; R2, the middle turn; R3, the apical turn） were calculated. And the paired t test was used to compare the differences in EH degree between the experimental and control group; Pearson correlation analysis was used to analyze the correlation between the cochlea EH degree and hearing loss and duration of symptoms. Results R1, R1 and R3 of ipsilateral cochlea were higher than normal cochlea （ipsilateral R 1：0.354±0.097 vs. normal R 1：0.185 ±0.031, P〈0.01; ipsilateral R2：0.445±0.098 vs. normal R2：0.201±0.046, P〈0.01; ipsilateral R3：0.467±0.102 vs. normal R3：0.221±0.053, P〈0.01）. A positive correlation was found between the degree of EH in each turn and high-frequency hearing loss （r=0.275, 0.281, 0.329, respectively; all P〈0.05）, whereas no correlation was found between the extent of EH and the time of vertigo, tinnitus and hearing loss （P〉0.05）. In addition, there was a correlation between the degree of EH in the apical turn and low, medium, high-frequency hearing loss （r=0.271, 0.269, 0.329, respectively; all P〈0.05）. Conclusions The degree of cochlea EH in the basal and second turn showed great relevance with the high-frequency hearing loss, and the apical turn EH degree was relevant with the low, medium, high-frequency hearing loss, but there was no correlation between the EH degree of each turn, ages and symptoms.