全频型突发性聋的疗效影响因素分析

Analysis of Factors Affecting Treatment Outcomes in All Frequency Sudden Sensorineural Hearing Loss

目的通过比较溶栓治疗全频型突发性聋患者前后凝血功能的变化和疗效,探讨全频型突发性聋的疗效预测指标。方法对64例于2017至2018年间在我科治疗的全频型突发性聋患者的凝血功能进行回顾性分析。根据纯音听阈变化将其分为有效组(n=33)与无效组(n=31),比较治疗前后凝血功能指标。结果与治疗前比较,治疗后两组患者的Fbg水平显著降低、TT显著延长、APTT显著缩短(P<0.05)。有效组治疗前后的Fbg水平均低于无效组(P<0.05),且有效组治疗前TT水平高于无效组(P<0.05)。回归分析示高龄、右侧发病、较低的TT值是全频型突发性聋预后的危险因素。线性回归提示治疗前Fbg水平与听力提高负相关,治疗前后Fbg变化值与治疗后听力值负相关。结论全频型突发性聋预后与年龄、发病侧别、凝血功能指标相关,溶栓治疗全频型突发性聋能显著改善凝血功能状态,Fbg可作为全频型突发性聋预后的预测指标。

Objective To report effects of thrombolytic therapy on coagulative function and hearing outcomes in patients with sudden sensorineural hearing loss(SSNHL)at all frequencies,and identify predictive indicators for outcomes.Methods Data from 64 consecutive patients with SSNHL at all frequencies diagnosed in our department between 2017 and 2018 were retrospectively analyzed and divided into an effective group(n=33)and an ineffective group(n=31)based on recovery of pure tone audiometry.Coagulation function parameters,including fibrinogen(Fbg),thrombin time(TT),prothrombin time(PT),and activated partial thromboplastin time(APTT)were analyzed.Results Compared with before treatment,Fbg levels were decreased,TT prolonged and APTT shortened significantly in both groups after treatment(P<0.05).Fbg levels were lower in the effective group than in the ineffective group before and after therapy(P<0.05),and TT level was higher in the effective group than in the ineffective group before treatment(P<0.05).Logistic regression analysis showed that advanced age,right side SSNHL and a lower TT value upon admission were predictive of unfavorable outcome in patients with severe to profound SSNHL.Linear regression showed that Fbg level was negatively correlated with hearing improvement,and the D-value of Fbg was negatively correlated with hearing thresholds after treatment.Conclusion Prognosis of all frequency SSNHL is related to age,disease side and coagulation indices.Thrombolytic therapy can significantly improve coagulation function in patients with SSNHL at all frequencies.Fbg may be taken into account as a predictive indicator of all frequency SSNHL outcomes to some degree.