不同侧别特发性耳鸣人群分布特征与严重性和情绪及认知变化特点的对比研究

Comparative analysis of population distribution,severity,emotional,and cognitive characteristics among different side idiopathic tinnitus patients

探讨不同侧别特发性耳鸣的人群分布特征与严重性和情绪及认知功能差异及其相关性,从而为早期预防和精准治疗提供依据。本研究采用横断面实验设计方法,收集2020年10月至2022年2月于首都医科大学附属北京同仁医院耳科就诊的右侧、左侧和双侧特发性耳鸣患者36例、44例及46例,记录患者基线资料并行耳鸣障碍评估量表(THI)、贝克抑郁量表(BDI)、状态特质焦虑量表(STAI)、蒙特利尔认知评估量表(MoCA)评估。应用单因素方差分析、多样本秩和检验或χ2检验分析不同侧别耳鸣临床特征、严重程度、抑郁、焦虑、认知损害差异,应用多元相关分析研究各组THI评分、耳鸣持续时间、听力阈值与BDI、STAI、MoCA评分之间的相关性。结果显示,不同侧别耳鸣组年龄、体重指数(BMI)、受教育年限、耳鸣持续时间及听力下降发生率差异均无统计学意义(F=0.730、P=0.484,F=1.535、P=0.219,F=1.506、P=0.226,χ2=4.242、P=0.120,χ2=6.672、P=0.083)。右侧、左侧和双侧耳鸣组重度耳鸣分别有12例、7例及20例,发生率分别是33.3%、15.9%及43.5%;抑郁分别有13例、14例及26例,发生率分别是36.1%、31.8%及53.5%;特质焦虑分别有3例、2例及10例,发生率分别是8.3%、4.5%及21.7%。其中双侧耳鸣组重度耳鸣、抑郁、特质焦虑的发生率明显高于左侧耳鸣组(χ2=8.139、P=0.004,χ2=5.558、P=0.018,χ2=5.753、P=0.007)。不同侧别耳鸣患者状态焦虑和认知损害发生率差异均无统计学意义(χ2=0.142、P=0.931,χ2=1.338、P=0.512),总体发生率分别是16.7%(21/126)和37.3%(47/126)。右侧耳鸣组THI评分与BDI、S-AI、T-AI评分呈正相关(r=0.529、P=0.001,r=0.649、P<0.001,r=0.483、P=0.003),与MoCA评分呈负相关(r=-0.364,P=0.029);左侧耳鸣组THI评分与BDI、S-AI、T-AI评分呈正相关(r=0.508、P<0.001,r=0.506、P<0.001,r=0.357、P=0.017);双侧耳鸣组THI评分与BDI、S-AI、T-AI评分呈正相关BDI(r=0.753、P<0.001,r=0.527、P<0.001,r=0.536、P<0.001),耳鸣持续时间与MoCA评分呈正相关(r=0.334,P=0.023)。

To provide basis for prevention and treatment by analyzing the clinical features,emotional and cognitive states and their correlations of idiopathic tinnitus.Cross-sectional study was used.Thirty-six right,44 left,and 46 bilateral idiopathic tinnitus patients diagnosed in Beijing Tongren Hospital were prospectively enrolled from October,2020 to February,2022.The clinical data was recorded and the THI,DBI,STAI,and MoCA were evaluated.The clinical features and the incidence of severe tinnitus,hearing lose,anxiety,and cognitive impairment were compared by one-way ANOVA,Kruskal-Wallis H,and chi-square test.The correlation between tinnitus or hearing and emotional and cognitive states were evaluated by multivariable correlation analysis.There was no significant difference in age,BMI,years of education,tinnitus duration,and the incidence of hearing loss among groups(F=0.730,P=0.484;F=1.535,P=0.219;F=1.506,P=0.226;χ²=4.242,P=0.120;χ²=6.672,P=0.083).In right,left,and bilateral tinnitus patients,the number of severe tinnitus was 12,7,and 20 cases and the incidence was 33.3%,15.9%,and 43.5%;the number of depression was 13,14,and 26 cases and incidence was 36.1%,31.8%,and 53.5%;the number of trait anxiety was 3,2,and 10 cases and the incidence was 8.3%,4.5%,and 21.7%.Compared with left tinnitus patients,the incidence of severe tinnitus,depression,and trait anxiety was higher in bilateral tinnitus patients(χ²=8.139,P=0.004;χ²=5.558,P=0.018;χ²=5.753,P=0.007).The incidence of state anxiety and cognitive impairment were no significant difference among groups(χ²=0.142,P=0.931;χ²=1.338,P=0.512).The overall incidence of state anxiety and cognitive impairment were 16.7%(21/126)and 37.3%(47/126)respectively.There was positive correlation between THI score and BDI,S-AI,and T-AI scores(r=0.529,P=0.001;r=0.649,P<0.001;r=0.483,P=0.003)and negative correlation between THI and MoCA scores(r=-0.364,P=0.029)in right tinnitus group.The positive correlation was found between THI score and BDI,S-AI,and T-AI scores in left tinnitus group(r=0.508,P<0.001;r=0.506,P<0.001;r=0.357,P=0.017).The positive correlation between THI score and BDI,S-AI,and T-AI scores(r=0.753,P<0.001;r=0.527,P<0.001;r=0.536,P<0.001)and the positive correlation between tinnitus duration and MoCA score(r=0.334,P=0.023)were also found in bilateral tinnitus group.