血清超敏C反应蛋白水平与突发性聋患者预后关系的研究

Correlations of Hypersensitive C-Reactive Protein in Serum With the Prognosis of Sudden Sensorineural Hearing Loss

目的探讨血清超敏C反应蛋白(Hs-CRp)水平与不同类型突发性聋患者预后的关系。方法回顾性分析2016年1月~2018年12月我院收治的150例突发性聋患者的临床资料,根据不同听阈曲线类型分为低频下降型、高频下降型、平坦下降型及全聋型,每型根据预后分为有效组和无效组。分析比较各类型组间的年龄、性别、身体质量指数(bodymass index,BMI)、基础疾病、病程、眩晕、耳鸣、疗效及血清Hs-CRp;以每一类型的无效作为因变量,将单因素分析中P<0.1的自变量进一步进行多因素logistic分析;使用受试者工作特征曲线评价预后不良危险因素的的敏感度及特异度,采用约登指数(youdenindex,YI)最大法确定独立危险因素的诊断界值。结果(1)不同听阈曲线类型组间比较,血清HsCRp、有效率及眩晕的组间差异有统计学意义(P<0.05),其余基本资料及临床特征差异无统计学意义(P>0.05);(2)logistic回归分析结果显示,低频下降型及高频下降型的预后与各项基本资料及临床特征无相关性,入院时高水平的HsCRp(OR=1.718,95%CI:1.125~2.625)及病程(OR=1.219,95%CI:1.005~1.478)是平坦下降型患者预后不良的危险因素,入院时高水平的Hs-CRp(OR=2.656,95%CI:1.312~5.379)也是全聋型患者预后不良的危险因素,是否伴有眩晕与全聋型患者的预后无明显关系(P<0.05);(3)平坦下降型组的Hs-CRp的ROC曲线下面积(AUC)为0.756(95%CI=0.615~0.897,P=0),Hs-CRp预测值为3.30 mg/L,敏感度为63%,特异度为96%,病程的AUC为0.650(95%CI=0.520~0.781,P=0.029),病程的预测值为6.5天,敏感度为52%,特异度为75%,联合预测因子L的AUC为0.767(95%CI=0.644~0.890,P=0),L的预测值为0.46,敏感度为56%,特异度为94%。全聋型的Hs-CRp的AUC为0.837(95%CI=0.710-0.963,P=0),Hs-CRp的预测值为3.36mg/L,敏感度为84%,特异度为79%。结论高水平的血清Hs-CRp是平坦下降型及全聋型突发性聋患者预后不良的危险因素,与低频下降型及高频下降型突发性聋患者的预后可能无关。

Objective To investigate the correlations of hypersensitive C-reactive protein(Hs-CRP)in serum with the prognosis of patients with different types of Sudden Sensorineural Hearing Loss(SSHL).Methods A retrospective cohort study involved 150 patients with SSHL from January 2016 to December 2018.The patients were divided into 4 groups according to different audiometric curves:hearing loss at low frequencies,high frequencies,flat type and total deafness;Each type was divided into effective group and ineffective group according to prognosis.Analysis of the age,gender,body mass index(BMI),underlying disease,course of disease,dizziness,tinnitus,curative effect and serum Hs-CRP among different groups of SSHL was conducted;The ineffective of each type of SSHL was used as the dependent variable,the independent variable with P<0.1 in univariate analysis were further performed with multivariate logistic regression analysis.The receiver operating characteristic curve(ROC)was used to evaluate the sensitivity and specificity of the prognostic risk factors,The youden index(YI)was calculated and the optimal cut-off value was determined.Results(1)The level of Hs-CRP in serum,effective rate and vertigo among the four groups of SSHL were significantly different(P<0.05).There was no significant difference in other basic data and clinical characteristics among the four groups(P>0.05);(2)The results of the multivariate logistic regression analysis indicated that the hearing loss at low frequencies,and high frequencies had no correlation with all basic data and clinical characteristics;the high level of Hs-CRP(OR=1.718,95%CI:1.125-2.625)and the course of disease(OR=1.219,95%CI:1.005-1.478)were the independent risk factors for poor prognosis in patients of flat type,the high level of Hs-CRP(OR=2.656,95%CI:1.312-5.379)was also a risk factor for poor prognosis in patients with total deafness;Vertigo had nothing to do with the prognosis of patients with total deafness(P<0.05);(3)The area under the ROC curve(AUC)of the Hs-CRP level in the group of flat type was 0.756(95%CI=0.615-0.897,P=0),when the predictive value of HsCRP level was 3.30 mg/L,its corresponding sensitivity was 63%and specificity was 96%,the AUC of the disease course was 0.650(95%CI=0.520-0.781,P=0.029).When the predictive value of disease course was 6.5 days,its corresponding sensitivity was 52%and specificity was 75%,the AUC of the combined predictor L was 0.767(95%CI=0.644-0.890,P=0);When the predictive value of L was 0.46,its sensitivity was 56%and specificity was 94%.The AUC of the Hs-CRP level in the group of total deafness was 0.837(95%CI=0.710-0.963,P=0);When the predictive value of Hs-CRP level was 3.36 mg/L,its sensitivity was 84%and specificity was 79%.Conclusion The higher Hs-CRP level is a risk factor for poor prognosis in SSHL patients of flat type and total deafness,but it may not be associated with the prognosis of patients with hearing loss at low frequencies and high frequencies.