难治性突发性聋患者预后相关因素分析

Analysis of prognostic factors in patients with refractory sudden sensorineural hearing loss

目的:探讨糖皮质激素(GC)敏感性与难治性突发性聋(突聋)预后的关系,并分析影响难治性突聋预后的相关因素。方法:前瞻性对照观察91例难治性突聋患者,治疗前行外周单个核细胞体外增殖地塞米松(DEX)抑制实验,局部进行以甲泼尼龙为主的综合治疗,分析难治性突聋发病后3个月的疗效及影响预后的相关因素。结果:难治性突聋患者治疗总有效率为40.66%,性别、耳侧别、年龄、是否伴有眩晕或耳鸣、甲泼尼龙的局部使用方式与疗效无关,仅DEX抑制率、发病至就诊时间与疗效有关(R^2=0.712,0.118,均P<0.01),并且DEX抑制率与疗效相关性更强,GC有效组的DEX抑制率显著高于GC无效组。结论:DEX抑制率可用来反映难治性突聋患者的GC敏感性及预后,GC敏感性和发病至就诊时间是影响难治性突聋患者的2个重要因素,通过CCK-8法了解难治性突聋患者GC敏感性并尽早开始局部GC治疗,可改善预后。

Objective:To explore the relationships between glucocorticoid(GC)sensitivity and the prognosis of refractory sudden sensorineural hearing loss(SSNHL),and to analyze the related factors being affected the prognosis of SSNHL.Method:Ninety-one refractory SSNHL patients were enrolled in the present investigation.Peripheral blood mononuclear cells(PBMCs)from the refractory SSNHL were extracted to conduct GC proliferation dexamethasone(DEX)inhibition experiments.All patients accepted comprehensive treatment with methylprednisolone.Result:Total effective rate was 40.66%in refractory SSNHL patients.Gender,number of affected ear,age,accompanying with vertigo,tinnitus or not and the procedure of methylprednisolone treatment were irrelevant to the efficacy.Only the inhibitory rate of DEX and the time from onset to visit were related to GC treatment effect,especially for inhibitory rate of DEX.The DEX inhibition rate of the effective group was higher than that of the ineffective group.Conclusion:DEX inhibition rate can predict GC sensitivity and prognosis of SSNHL.GC sensitivity and the time from onset to treatment are two important factors affecting the prognosis of refractory SSNHL patients.