突发感音神经性聋患者血清钙卫蛋白和清蛋白表达水平及其与预后的相关性研究

Serum Calprotectin and Albumin Expression Levels in Patients with Sudden Sensorineural Deafness and Their Correlation with Prognosis

目的分析突发感音神经性聋(sudden sensorineural hearing loss,SSNHL)患者血清钙卫蛋白(calprotectin,Cal)、清蛋白(albumin,Alb)水平变化及其与预后的相关性。方法前瞻性选取2020年1月~2022年1月邯郸市眼科医院收治的157例SSNHL患者为SSNHL组,其中32例轻度听力损失、68例中度听力损失、40例重度听力损失和17例极重度听力损失,根据10天后临床疗效分为预后不良组59例和预后良好组98例。另选取同期体检健康且听力正常、无耳部病理疾病史的志愿者为对照组,采用ELISA法检测血清Cal水平,溴甲酚绿比色法检测血清Alb水平。Pearson/Spearman相关系数分析SSNHL患者血清Cal和Alb水平与纯音平均听阈(pure tone average,PTA)的相关性,多因素Logistic回归分析SSNHL患者预后不良影响因素,受试者工作特征(receiver operating characteristic,ROC)曲线分析血清Cal和Alb水平对SSNHL患者预后不良的预测价值。结果SSNHL组血清Cal水平为77.74±18.73ng/ml,高于对照组的44.79±20.70ng/ml,Alb水平为40.46±3.67g/L,低于对照组的46.65±2.25g/L,差异有统计学意义(t=9.953,15.463,均P<0.001)。轻度、中度、重度和极重度听力损失组血清Cal水平依次升高(50.19±11.07,69.91±11.29,85.19±10.04,97.18±18.19ng/ml),Alb水平依次降低(43.53±2.13,42.07±2.55,37.39±2.30,35.42±1.38g/L),差异均有统计学意义(F=78.440,80.650,均P<0.001)。Pearson/Spearman相关系数显示,SSNHL患者PTA与血清Cal水平呈正相关(r=0.734,P<0.001),与Alb水平呈负相关(r=-0.751,P<0.001),血清Cal与Alb水平呈负相关(r=-0.548,P<0.001)。多因素Logistic回归分析显示,全聋型、PTA增加、嗜中性粒细胞计数升高、单核细胞计数升高、Cal升高为SSNHL患者预后不良的独立危险因素(OR=1.035~1.539,均P<0.05),淋巴细胞计数升高、Alb升高为独立保护因素(OR=0.377,0.866,均P<0.05)。ROC曲线显示,血清Cal,Alb水平单独和联合预测SSNHL患者预后不良的曲线下面积为0.688,0.693和0.752,联合预测的曲线下面积大于单独预测,差异有统计学意义(Z=2.174,2.154,均P<0.05)。结论SSNHL患者血清Cal水平升高,Alb水平降低,与SSNHL患者听力损失程度和预后不良有关,可能成为SSNHL患者预后的辅助评估指标。

Objective To analysis the changes of serum calprotectin(Cal)and albumin(Alb)levels in patients with sudden sensorineural hearing loss(SSNHL)and their correlation with prognosis.Methods Prospectively,157 patients with SSNHL admitted to Handan Eye Hospital from January 2020 to January 2022 were selected as the SSNHL group,including 32 cases of mild hearing loss,68 cases of moderate hearing loss,40 cases of severe hearing loss and 17 cases of very severe hearing loss,which were divided into 59 cases in the poor prognosis group and 98 cases in the good prognosis group according to the clinical outcome after 10 days.Volunteers who were physically healthy and had normal hearing and no history of ear pathology were also selected as the control group.Serum Cal levels was measured by ELISA and serum Alb levels by bromocresol green colorimetric method.Pearson/Spearman correlation coefficients were used to analyze the correlation between serum Cal and Alb levels and pure tone average(PTA)in SSNHL patients,factors influencing poor prognosis in SSNHL patients was analyzed by multi-factor logistic regression,and the predictive value of serum Cal and Alb levels on poor prognosis in SSNHL patients was analyzed using r e c e i v e r o p e r a t i n g c h a r a c t e r i s t i c(R O C)c u r v e s.R e s u l t s S e r u m C a l l e v e l s w e r e h i g h e r i n t h e S S N H L group(77.74±18.73 ng/ml)than in the control group(44.79±20.70 ng/ml),and Alb levels were lower in the SSNHL group(40.46±3.67 g/L)than in the control group(46.65±2.25 g/L),with the differences were statistically significant(t=9.953,15.463,all P<0.001).Serum Cal levels were increased in the mild,moderate,severe and profound hearing loss groups in the following order(50.19±11.07,69.91±11.29,85.19±10.04,97.18±18.19 ng/ml)and Alb levels were decreased in the following order(43.53±2.13,42.07±2.55,37.39±2.30,35.42±1.38 g/L),and the differences were statistically significant(F=78.440,80.650,all P<0.001).Pearson/Spearman correlation coefficients showed that PTA were positively correlated with serum Cal levels and negatively correlated with Alb levels in SSNHL patients(r=0.734,-0.751,all P<0.001),and serum Cal was negatively correlated with Alb levels(r=-0.548,all P<0.001).Multi-factor logistic regression analysis showed that total deafness,increased PTA,increased neutrophil count,increased monocyte count and increased Cal were independent risk factors for poor prognosis in SSNHL patients(OR=1.035~1.539,all P<0.05),and increased lymphocyte count,increased Alb were independent protective factors(OR=0.377,0.866,all P<0.05).The ROC curves showed that the area under the curve for serum Cal and Alb levels alone and in combination to predict poor prognosis in SSNHL patients were 0.688,0.693 and 0.752,respectively with the area under the curve for the combination being greater than that for the prediction alone,with statistically significant differences(Z=2.174,2.154,all P<0.05).Conclusion Elevated serum Cal levels and reduced Alb levels were associated with the degree of hearing loss and poor prognosis in SSNHL patients and may be an adjunctive assessment indicator of prognosis in SSNHL patients.