梅尼埃病患者水平半规管损伤频率特性及壶腹嵴超微结构分析

Frequency characteristics of horizontal semicircular canals damage and the ultrastructure analysis of crista ampullaris in patients with Meniere′s disease

目的:探讨梅尼埃病患者水平半规管损伤的频率特性及壶腹嵴病理学特征,分析其损伤频率特征的结构基础。方法:研究对象为山东省耳鼻喉医院2019年3—11月收治的72例梅尼埃病患者,其中男27例,女45例,年龄13~74岁,病程4个月~32年。全部患者均行冷热试验、正弦谐波加速试验(sinusoidal harmonic acceleration test,SHA)、视频头脉冲试验(video-head impulse test,v-HIT)、经静脉注射内耳钆增强3D-FLAIR MRI和纯音听阈测试,分析梅尼埃病患者水平半规管功能检测结果特点及与内淋巴积水程度、临床分期和病程的相关性。对其中6例行迷路切除术的难治性梅尼埃病患者的水平半规管壶腹嵴进行光学显微镜及透射电镜观察,对Ⅰ型和Ⅱ型毛细胞进行计数比较,并观察水平半规管壶腹嵴的常见病理改变。应用SPSS 19.0软件进行统计学分析。结果:随着检测频率升高,梅尼埃病患者水平半规管功能异常率逐渐降低,冷热试验异常率69.4%(50/72)、SHA试验51.4%(37/72)、v-HIT 36.1%(26/72),三项检查间两两比较异常率差异均有统计学意义(P值均<0.05)。冷热试验、SHA结果与积水程度无相关性(P值均>0.05),v-HIT与积水程度有相关性(r=0.434,P<0.01);冷热试验与临床分期无相关性(P>0.05),而SHA、v-HIT与临床分期有相关性(r=0.338及0.462,P值均<0.01);冷热试验、SHA、v-HIT与病程均无相关性(P值均>0.05)。病理学检查可见水平半规管壶腹嵴感觉上皮单层变性,Ⅱ型毛细胞较Ⅰ型毛细胞减少更显著,毛细胞核周空泡、细胞质空泡化、线粒体电子密度增高、纤毛缺失。结论:梅尼埃病患者水平半规管损伤存在频率特性,主要损伤低频区,随疾病发展逐渐出现高频区损伤,并与内淋巴积水程度和听力损伤程度相关。梅尼埃病患者壶腹嵴存在毛细胞损伤,其损伤频率特性可能与壶腹嵴Ⅱ型毛细胞较早出现损伤或损伤较重有关。

Objective To investigate the frequency characteristics and the pathological characteristics of the horizontal crista ampullaris in patients with Meniere′s disease,and to analyse its structural basis.Methods Between March,2019 and November,2019,seventy-two patients diagnosed as Meniere′s disease(27 males and 45 females,aged from 13 to 74 years,with a course of disease ranging from 4 months to 32 years)in Shandong Provincial ENT Hospital were included.Caloric test,sinusoidal harmonic acceleration test(SHA),video-head impulse test(v-HIT),Gadolinium-enhanced inner-ear 3D-FLAIR MRI and pure tone audiometry were conducted in the patients.The function of the horizontal semicircular canal in these patients were analysed as well as its relationship with the degree of endolymphatic hydrops,clinical stage and duration.Light microscopy and transmission electron microscopy were used to observe the ultrastructure of horizontal semicircular canal crista ampullaris from six patients with refractory Meniere′s disease who underwent labyrinthectomy.The number of typeⅠand typeⅡvestibular hair cells,the common pathophysiological changes of horizontal semicircular canal crista ampullaris were investigated in these patients.Statistical analysis was performed using SPSS 19.0.Results With the increase of detection frequency,the abnormal rate decreased gradually.The abnormal rate of caloric test was 69.4%(50/72),SHA 51.4%(37/72),V-HIT 36.1%(26/72),comparation of the positive rate among the three tests showed statistically significant differences(P<0.05).Neither caloric test nor SHA had correlation with the degree of hydrops(P>0.05),but v-HIT(r=0.434,P<0.01).There was correlation with clinical stage to SHA and v-HIT(r=0.338,0.462,P<0.01),except caloric test(P>0.05).No significant relation was found with caloric test,SHA,v-HIT and course of disease(P>0.05).Morphological observation found abnormal monolayer epithelialization of the horizontal semicircular canal crista ampullaris significantly decreased number of typeⅡhair cells compared with typeⅠhair cells.Hair cells showed perinuclear vacuolization,cytoplasmic vacuoles,mitochondrial electron density increasement and loss of stereocilia.Conclusions The horizontal semicircular canal damage in the patients with Meniere′s disease has a frequency-dependent characteristic,mainly occurres in low frequency area.With progress of the disease,the high frequency area of ampulla will be impaired gradually,and it is related to the degree of endolymphatic hydrops and hearing level.Hair cell injury would be observed,the frequency characteristics may be more associated with the disorder of typeⅡhair cells.