梅尼埃病内淋巴积水程度与临床特征的相关性分析

Correlation Analysis between Degree of Endolymphatic Hydrops and Clinical Characteristics in Meniere's Disease

目的探讨梅尼埃病(meniere's disease,MD)患者内淋巴积水(endolymphatic hydrops,EH)程度与临床特征的相关性。方法研究对象为2020年12月—2022年3月就诊北京清华长庚医院的31例MD患者,所有患者均行纯音测听(pure tone audiometry,PTA)、耳蜗电图(electrocochleogram,ECochG)、耳鸣分级、眩晕残障程度评定量表(dizziness handicap inventory,DHI)评分及内耳钆造影MRI扫描。据内耳MRI显像,采用目测4分法,以3D FLAIR序列评估前庭积水程度,以3D real IR序列评估耳蜗积水程度,采用Spearman秩相关检验和Fisher精确检验分析EH程度与患者临床特征的相关性。结果不同EH程度患者的性别、年龄、侧别及病程比较,差异无统计学意义(P>0.05);Spearman相关性分析显示,耳蜗积水程度与耳鸣分级、低频听阈、平均听阈及疾病分期呈正相关(r_(s)=0.517、0.438、0.439、0.378,P<0.05),与ECochG无明显相关性(P>0.05);前庭积水程度与发作频率呈正相关(r_(s)=0.361,P<0.05),与DHI及其躯体、情绪、功能方面评分无明显相关性(P>0.05)。结论应用内耳钆造影不同MRI序列评估EH程度发现与MD患者听力、疾病分期、眩晕发作频率及耳鸣分级有相关性,可用于临床诊断MD、评估患者EH程度。

Objective To study the correlation between the degree of endolymphatic hydrops(EH)and clinical characteristics in Meniere's disease(MD)patients.Methods From December 2020 to March 2022,31 MD patients admitted to the Beijing Tsinghua Changgung Hospital were enrolled.Pure tone audiometry(PTA),electrocochleogram(ECochG),tinnitus grading,dizziness handicap inventory(DHI)scale and gadolinium-enhanced MRI data were collected.The degree of vestibular hydrops was assessed by 3D fluid-attenuated inversion recovery sequence(3D FLAIR)whereas the degree of cochlear hydrops was evaluated by high-resolution 3D real reconstruction inversion recovery sequence(3D real IR)MRI scans,using the visual quartering method.The correlation between the degree of EH and clinical characteristics was analyzed by the Spearman test and Fisher’s exact test.Results There was no statistically significant difference in age,gender,side,or disease duration among patients with varying degrees of EH(P>0.05).Spearman correlation analysis showed that the degree of cochlear hydrops was positively correlated to tinnitus grading,low-frequency hearing thresholds,average hearing thresholds and disease stage(r_(s)=0.517,0.438,0.439 and 0.378,respectively,P<0.05),but not to ECochG(P>0.05).The degree of vestibular hydrops was positively associated with the frequency of vertigo attacks(r_(s)=0.361,P<0.05),although not with the DHI score including physical,emotional,and functional aspects(P>0.05).Conclusion Based on gadolinium-enhanced inner ear MRI with different sequences,the degree of EH in MD patients is correlated with hearing,disease stage,frequency of vertigo attacks and tinnitus grading.MRI can be effectively used for clinical diagnosis and evaluation of EH in MD patients.