糖尿病与听力下降相关性的回顾性病例对照研究

Association between diabetes and hearing loss:A retrospective case-control study

背景听力下降为糖尿病的并发症之一,但目前重视程度较其他并发症低,且各指南较少提及糖尿病听力下降的问题。目的本研究旨在探讨糖尿病与听力下降的相关性。方法收集2022年9月—2023年3月在南部战区总医院内分泌科住院的糖尿病患者222例,根据是否存在听力下降分为听力正常组和听力下降组。采用有序多分类Logistic回归分析评价糖尿病患者听力下降严重程度的相关危险因素。结果共纳入222例糖尿病患者,其中听力下降组和听力正常组分别有165例和57例。听力下降组男性95例(57.6%),听力正常组男性38例(66.7%),两组间差异无统计学意义(P>0.05)。与听力正常组相比,听力下降组年龄较大[(62.79±10.60)岁vs(47.53±10.17)岁,P<0.001]、病程较长[M(IQR):11.36(4.00~18.00)年vs 6.77(1.00~9.75)年,P<0.001]、收缩压较高[(133.85±22.12)mmHg vs(126.21±16.19)mmHg,P=0.006]、肌酐/尿微量白蛋白较高[M(IQR):215.68(83.47~347.89)mg/gCr vs 40.68(21.55~59.81)mg/gCr,P=0.013],血糖变异系数(coefficient of variation,CV)较高[M(IQR):30.20(24.61~35.99)%vs 27.97(21.12~32.79)%,P=0.034]、平均血糖(mean blood glucose,MBG)较高[(9.49±2.03)mmol/L vs(8.73±1.72)mmol/L,P=0.012]、平均血糖标准差(standard deviation of mean blood glucose,SDBG)较高[(2.90±1.01)mmol/L vs(2.48±0.96)mmol/L,P=0.007]、肾小球滤过率较低[M(IQR):82.19(69.00~98.00)mL/(min·1.73 m^(2))vs 100.15(89.25~118.00)mL/(min·1.73 m^(2)),P<0.001]。有序多分类Logistic回归分析显示,糖尿病病程(OR=1.047,95%CI:1.015~1.080)、SDBG(OR=1.337,95%CI:1.002~1.783)、高血压(OR=1.721,95%CI:1.017~2.913)、冠心病(OR=1.970,95%CI:1.019~3.806)为不同严重程度下糖尿病听力下降的危险因素。结论45~59岁(中年)糖尿病患者听力下降风险更高,且糖尿病病程<3年时听力下降的风险已较高,以高频听力下降和轻度听力下降为主,利用电测听结合DPOAE可更早期、更准确地发现糖尿病听力下降。

Background Hearing loss is one of the complications of diabetes,but it is less recognized than other complications.And the guidelines do not mention hearing loss in diabetes.Objective To explore the association between diabetes and hearing loss.Methods Totally 222 patients with diabetes mellitus admitted to the Department of Endocrinology and Metabolism,General Hospital of Guangzhou Military Command of PLA,from September 2022 to March 2023 were collected and divided into normal hearing group and hearing loss group according to whether they had diabetes mellitus hearing loss.Ordinal multinomial Logistic regression analysis was used to evaluate the related risk factors for the severity of hearing loss in diabetic patients.Results A total of 222 diabetic patients were enrolled,including 165 patients in the hearing loss group and 57 patients in the normal hearing group.There were 95 males(57.6%)in the hearing loss group and 38 males(66.7%)in the normal hearing group,with no significant difference between the two groups(P>0.05).Compared with the normal hearing group,patients with hearing loss were older([62.79±10.60]years vs[47.53±10.17]years,P<0.001),had longer disease duration(M[IQR]:11.36[4.00-18.00]years vs 6.77[1.00-9.75]years,P<0.001)and higher systolic blood pressure([133.85±22.12]mmHg vs[126.21±16.19]mmHg,P=0.006),higher creatinine/urinary microalbumin ratio(M[IQR]:215.68[83.47-347.89]mg/gCr vs 40.68[21.55-59.81]mg/gCr,P=0.013).The coefficient of variation of blood glucose(M[IQR]:30.20[24.61-35.99]%vs 27.97[21.12-32.79]%,P=0.034),the mean blood glucose([9.49±2.03]mmol/L vs[8.73±1.72]mmol/L,P=0.012),and the standard deviation of mean blood glucose were also higher([2.90±1.01]mmol/L vs[2.48±0.96]mmol/L,P=0.007).However,the estimated glomerular filtration rate was lower(M[IQR]:82.19[69.00-98.00]mL/[min·1.73m^(2)]vs 100.15[89.25-118.00]mL/[min·1.73m^(2)],P<0.001).There were significant differences in diabetic retinopathy,diabetic kidney disease,hypertension and coronary heart disease between the two groups(all P<0.05).Ordinal multinomial logistic regression analysis showed that the course of disease(OR=1.047,95%CI:1.015-1.080),SDBG(OR=1.337,95%CI:1.002-1.783),hypertension(OR=1.721,95%CI:1.017-2.913)and coronary atherosclerotic cardiopathy(OR=1.970,95%CI:1.019-3.806)were risk factors for hearing loss in patients with different severity of diabetes.Conclusion The risk of hearing loss is higher in middle-aged(45-59 years old)diabetic patients,and the risk of hearing loss is higher when the duration of diabetes is less than 3 years,mainly presents as high-frequency hearing loss and mild hearing loss.The use of electrical audiometry combined with DPOAE can detect diabetic hearing loss earlier and more accurately.