银杏叶提取物联合复方倍他米松耳后注射治疗突发性耳聋的临床效果

Clinical efficacy of ginkgo biloba extract combined with compound betamethasone injection for sudden sensorineural hearing loss

目的探讨银杏叶提取物(GBE)静滴联合复方倍他米松耳后注射治疗突发性耳聋(SSNHL)的效果及对患者听力水平、血管内皮生长因子(VEGF)信号通路相关指标的影响,为临床治疗SSNHL提供参考。方法选取2021年1月—2023年3月重庆市大足区人民医院收治的86例SSNHL患者为研究对象,采用随机数字表法分为对照组和观察组,每组43例。2组患者均给予基础治疗,对照组患者在基础治疗基础上采用复方倍他米松耳后注射治疗,观察组患者在对照组基础上联合GBE静滴治疗。比较2组患者治疗后的临床疗效,治疗前后听力水平及血液流变学指标[血浆黏度(PV)、全血黏度(WBV)、血细胞比容(HCT)]、内耳微循环指标[可溶性血管细胞黏附分子(s VCAM)、内皮素(ET)]、VEGF信号通路相关指标[VEGF、缺氧诱导因子1α(HIF-1α)]等指标水平,同时比较2组患者不良反应发生情况。结果观察组患者的治疗总有效率为93.02%(40/43),高于对照组的76.74%(33/43),差异有统计学意义(χ^(2)=4.440,P=0.035)。治疗前,2组患者各频区听阈比较,差异均无统计学意义(P>0.05);治疗10 d后,2组患者高频区听阈、低频区听阈及平均听阈均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者PV、WBV、HCT水平比较,差异均无统计学意义(P>0.05);治疗10 d后,2组患者PV、WBV、HCT水平均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者血清s VCAM、ET水平比较,差异均无统计学意义(P>0.05);治疗10 d后,2组患者血清s VCAM、ET水平均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者血清VEGF、HIF-1α水平比较,差异均无统计学意义(P>0.05);治疗10 d后,2组患者血清VEGF、HIF-1α水平均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。对照组与观察组患者不良反应发生率分别为9.30%(4/43)和11.63%(5/43),差异无统计学意义(χ^(2)=0.000,P=1.000)。结论GBE静滴联合复方倍他米松耳后注射治疗SSNHL,能够下调ET、s VCAM水平,且通过激活HIF-1α-VEGF轴,可有效调节内耳血液流变学指标,从而改善患者临床症状,提高听力水平。

Objective To explore the efficacy of intravenous ginkgo biloba extract(GBE)combined with compound betamethasone injection for the treatment of sudden sensorineural hearing loss(SSNHL)and its effects on patients'hearing levels and vascular endothelial growth factor(VEGF)signaling pathways,providing a reference for its clinical treatment.Methods A total of 86 SSNHL patients treated at the People's Hospital of Dazu,Chongqing from January 2021 to March 2023 were selected and randomly allocated to a control group and an observation group,with 43 cases each.Both groups received basic treatment;the control group was additionally treated with compound betamethasone injection behind the ear,while the observation group received GBE intravenous drip combined with the control group's treatment.The clinical efficacy,pre-and post-treatment hearing levels,hemorheological indicators[plasma viscosity(PV),whole blood viscosity(WBV),hematocrit(HCT)],inner ear microcirculation indicators[soluble vascular cell adhesion molecule(sVCAM),endothelin(ET)],and VEGF signaling pathway indicators[VEGF,hypoxia-inducible factor-1α(HIF-1α)]were compared between the two groups,as well as the incidence of adverse reactions.Results The overall response rate in the observation group was significantly higher than that in the control group[93.02%(40/43)vs.76.74%(33/43);χ^(2)=4.440,P=0.035].Before treatment,there were no significant differences in hearing thresholds across frequency ranges between the two groups(P>0.05);after 10 days of treatment,hearing thresholds in the high-frequency,low-frequency,and average thresholds were significantly lower in both groups compared to before treatment,with the observation group showing signif-icantly lower levels than the control group(P<0.05).No significant differences were noted in PV,WBV,and HCT levels between the two groups before treatment(P>0.05);after 10 days of treatment,these levels were significantly lower in both groups compared to before treatment,with the observation group being significantly lower than the control group(P<0.05).Before treatment,no significant differences were observed in serum sVCAM and ET levels between the two groups(P>0.05);after 10 days of treatment,these levels were significantly lower in both groups compared to before treatment,with the observation group being significantly lower than the control group(P<0.05).Before treatment,no significant differences were found in serum VEGF and HIF-1αlevels between the two groups(P>0.05);after 10 days of treatment,these levels were significantly lower in both groups compared to before treatment,with the observation group being signifi-cantly lower than the control group(P<0.05).The incidence of adverse reactions in the control and observation groups was 9.30%(4/43)and 11.63%(5/43),respectively,with no significant difference(χ^(2)=0.000,P=1.000).Conclusion In-travenous GBE combined with compound betamethasone injection for SSNHL can lower ET and sVCAM levels and effec-tively regulate inner ear hemorheological indicators through the activation of the HIF-1α-VEGF axis,thereby improving clin-ical symptoms and enhancing hearing levels.