GM1注射液联合高压氧治疗突发性耳聋的疗效及机制分析

Effects of GM1 injection combined with hyperbaric oxygen on sudden deafness and its related mechanism

目的分析单唾液酸四己糖神经节苷脂钠(GM1)注射液联合高压氧治疗突发性耳聋的疗效及其相关机制。方法选取2016年5月至2018年7月青岛市市立医院耳鼻喉科收治的突发性耳聋患者200例,将所有患者随机分为常规组(常规药物治疗)、GM1组(常规药物+GM1注射液)、高压氧组(常规药物+高压氧)、GM1+高压氧组(常规药物+GM1注射液+高压氧),每组各50例,比较4组患者治疗后临床疗效,以及治疗前后气导平均听阈、症状积分、全血黏度、血浆黏度、纤维蛋白原及血管内皮生长因子(VEGF)、细胞间黏附因子-1(ICAM-1)、可溶性血管细胞黏附分子-1(sVCAM-1)水平变化,观察4组患者治疗期间不良反应的发生情况。结果GM1+高压氧组患者治疗总有效率为98.00%,明显高于其他3组(78.00%、82.00%、86.00%),差异有统计学意义(P<0.05);治疗后各组患者气导平均听阈均较治疗前明显降低,差异有统计学意义(P<0.05);各组患者症状积分均较治疗前明显降低,差异有统计学意义(P<0.05);GM1+高压氧组气导平均听阈和症状积分均明显低于其他3组,差异有统计学意义(P<0.05);治疗后各组患者全血黏度、血浆黏度、纤维蛋白原均较治疗前明显降低,且GM1+高压氧组明显低于其他3组,差异有统计学意义(P<0.05);治疗后各组VEGF水平均较治疗前明显升高,且GM1+高压氧组明显高于其他3组,差异有统计学意义(P<0.05),ICAM-1、sVCAM-1水平均低于治疗前,GM1+高压氧组明显低于其他3组,差异有统计学意义(P<0.05);GM1+高压氧组不良反应总发生率略高于其他3组,但差异无统计学意义(P>0.05)。结论GM1注射液联合高压氧治疗突发性耳聋疗效显著,可明显提高患者听力,且安全性较高。

Objective To investigate the therapeutic effect of monosialoganglioside sodium(GM1)injection combined with hyperbaric oxygen(HBO)in the treatment of sudden deafness and to analyze its related mechanism.Methods A total of 200 patients with sudden deafness admitted into the Department of Otorhinolaryngology,Head and Neck Surgery of Qingdao Municipal Hospital from May 2016 to July 2018 were selected and randomly divided into four groups:conventional group(conventional medical treatment),GM1 group(conventional medical treatment+GM1 injection),HBO group(conventional medical treatment+HBO treatment),and GM1+HBO group(conventional medical treatment+GM1 injection+HBO),each consisting of 50 patients.The clinical effects of the four groups after treatment were compared,the changes of the average air-conduction hearing threshold,symptom score,and the levels of whole blood viscosity,plasma viscosity,fibrinogen and vascular endothelial growth factor(VEGF),intercellular adhesion factor-1(ICAM-1),soluble vascular cell adhesion molecule-1(sVCAM-1)before and after treatment were recorded and compared.The incidences of adverse reactions during the treatment in each group were observed.Results The total effective rate of the GM1+HBO group was 98.00%,which was significantly higher than those of the other three groups(78.00%,82.00%,and 86.00%)(P<0.05);in each group,after treatment,the average air-conduction hearing threshold of the patients was significantly lower than that before treatment(P<0.05),and the symptom score of the patient was significantly lower than that before treatment(P<0.05);after treatment,the average air-conduction hearing threshold and symptom score of the patients in the GM1+HBO group were significantly lower than those in the other three groups(P<0.05);after treatment,the levels of whole blood viscosity,plasma viscosity,and fibrinogen in each group were significantly lower than those before treatment,especially,those in the GM1+HBO group were significantly lower than those in the other three groups(P<0.05);after treatment,the level of VEGF in each group was significantly higher than that before treatment,especially,that in the GM1+HBO group was significantly higher than those in the other three groups(P<0.05);the levels of ICAM-1 and sVCAM-1 were lower than those before treatment,and those in the GM1+HBO group were significantly lower than those in the other three groups(P<0.05).The total incidence of adverse reactions in the GM1+HBO group was slightly higher than those in the other three groups,but the differences were not statistically significant(P>0.05).Conclusion GM1 injection combined with HBO is effective in the treatment of sudden deafness,which can significantly improve the hearing of patients.It may be achieved by repairing the damaged endothelium through improving the coagulation and vascular endothelial function of patients.The therapy is worthy of clinical application.