本文選題：2型糖尿病　切入點：聽力損傷　出處：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景及目的:糖尿病是常見的慢性內(nèi)分泌代謝性疾病,可以合并心腦大血管及視網(wǎng)膜、腎臟、周圍神經(jīng)等微血管病變,而這些并發(fā)癥會大大影響患者的生活質(zhì)量。近年來,關(guān)于糖尿病和內(nèi)耳的研究越來越多,已經(jīng)有研究證明糖尿病病人比非糖尿病患者聽力損害發(fā)生率明顯增高。目前的研究發(fā)現(xiàn),糖尿病造成的聽力損傷典型表現(xiàn)為雙耳漸進(jìn)性的感音神經(jīng)性聽力減退,首先累及高頻。但糖尿病性聽力損傷的發(fā)病機制尚未完全明確,可能的機制為:外毛細(xì)胞的喪失,微血管壁增厚,螺旋神經(jīng)節(jié)神經(jīng)元萎縮和電解質(zhì)紊亂等。一些證據(jù)表明,內(nèi)耳和腎臟有相似性,尤其是在解剖結(jié)構(gòu)及生理學(xué)上。通過電子顯微鏡下的觀察,內(nèi)耳的血管紋與腎臟的腎小球都是與微血管密切相關(guān)的上皮結(jié)構(gòu)。糖尿病重要的微血管并發(fā)癥有很多,而本研究旨在評估合并或不合并糖尿病腎病的糖尿病患者的前庭-聽力功能損傷,探討糖尿病患者臨床指標(biāo)與前庭-聽力功能損傷的關(guān)系。方法:第1組即NC組(15男,15女,60只耳)為正常健康人,作為對照組。2型糖尿病患者60人,并根據(jù)尿白蛋白/肌酐比值(ACR)分為兩組。第2組即DM組(15男,15女,60只耳)為糖尿病患者未合并糖尿病腎病,第3組即DN組(14男,16女,60只耳)為糖尿病患者合并糖尿病腎病。分別統(tǒng)計每個人的糖尿病病程、血壓、BMI、腰圍、C肽、胰島素、肌酐、尿素氮、腎小球濾過率、總膽固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、尿酸、糖化血紅蛋白、眼底照相、神經(jīng)傳導(dǎo)及頸動脈超聲檢查等。并分別檢測三組受試者的純音測聽、耳聲發(fā)射、視頻眼震電圖描記、冷熱水試驗及前庭誘發(fā)的肌源性電位。分別對三組受試者聽力及前庭功能結(jié)果進(jìn)行統(tǒng)計,并觀察臨床指標(biāo)與內(nèi)耳損傷的相關(guān)關(guān)系。所有數(shù)據(jù)均應(yīng)用SPSS21.0統(tǒng)計軟件進(jìn)行分析。結(jié)果:1.臨床指標(biāo)觀察結(jié)果由表1可知,兩組糖尿病患者糖化血紅蛋白、空腹血糖、收縮壓、腰臀比、甘油三酯、總膽固醇、低密度脂蛋白、高密度脂蛋白、尿酸水平明顯高于健康組(p0.05)。此外,DM組BMI、腰圍及同型半朧氨酸水平上與NC組有明顯統(tǒng)計學(xué)差異(p0.05)。DM組與DN組病程、同型半胱氨酸及胱抑素C水平有統(tǒng)計學(xué)差異(p0.05),肌酐、尿素氮、腎小球濾過率等無統(tǒng)計學(xué)差異(p0.05)。DM組中7名(23.33%)患者有眼底病變,8名(26.67%)患者有周圍神經(jīng)病變,12名(40%)病人有頸動脈超聲異常。DN組中27名(90%)患者有眼底病變,23名(76.67%)患者有周圍神經(jīng)病變,27名(90%)患者有頸動脈超聲異常。兩組糖尿病患者有統(tǒng)計學(xué)差異(p0.05)2.純音測聽結(jié)果由圖1可知,兩組糖尿病患者左耳(500、1000、2000、4000、8000Hz)和右耳(500、1000、2000、4000、8000Hz)與 NC 組有統(tǒng)計學(xué)差異(p0.05),且DN組比DM組左耳250、8000Hz及右耳8000Hz處的聽力損傷更嚴(yán)重(p0.05)。兩耳無統(tǒng)計學(xué)差異(p0.05)。糖化血紅蛋白、腰圍、尿白蛋白/肌酐比值及腎小球濾過率與聽力損傷有相關(guān)關(guān)系。3.耳聲發(fā)射由圖2可知,DN組患者在左耳(4kHz)和右耳(0.75、2、4kHz)處與NC組比較有統(tǒng)計學(xué)差異(p0.05)。DM組在右耳0.75kHz、4kHz處與NC組有統(tǒng)計學(xué)差異(p0.05)。兩耳比較無差異(p0.05)。4.視頻眼震電圖描記和冷熱水試驗由表2可知,視頻眼震電圖描記結(jié)果三組均為正常。冷熱水試驗結(jié)果中,DM組中5人表現(xiàn)為前庭功能受損,DN組中9人表現(xiàn)為前庭功能受損。但兩組無統(tǒng)計學(xué)差異(p0.05)。糖化血紅蛋白及尿白蛋白/肌酐比值與前庭功能損傷有相關(guān)關(guān)系。5.前庭誘發(fā)的肌源性電位NC組2人(6.67%)右耳未引出振幅,1人(3.33%)左耳未引出振幅;DM組3人(10%)右耳未引出振幅,1人(3.33%)左耳未引出振幅,2人(6.67%)雙耳均未引出振幅;DN組5人(16.67%)右耳未引出振幅,2人(6.67%)左耳未引出振幅,3人(10%)雙耳均未引出振幅。由表3可知,兩組糖尿病組左耳及右耳振幅與健康人比有統(tǒng)計學(xué)差異(p0.05),但DM組與DN組兩耳振幅均無統(tǒng)計學(xué)差異(p0.05))。由表5、表6可知VEMPs振幅降低與糖尿病病程、糖化血紅蛋白、低密度脂蛋白及糖尿病視網(wǎng)膜病變與前庭功能損傷有相關(guān)關(guān)系。結(jié)論:1.糖尿病患者比非糖尿病患者聽力損傷發(fā)生率高,表現(xiàn)為雙側(cè)漸進(jìn)性的感音神經(jīng)性聽力損傷,且以高頻為主。合并糖尿病腎病患者與未合并糖尿病腎病患者相比,發(fā)生率高。2.聽力損傷出現(xiàn)的較早,前庭損傷出現(xiàn)較晚。表明內(nèi)耳損傷是一個逐漸進(jìn)展的過程,有聽力損害的患者容易出現(xiàn)前庭功能的損傷。3.糖化血紅蛋白、腰圍、尿微量白蛋白/肌酐比值及腎小球濾過率與聽力損傷有相關(guān)關(guān)系,可以增加2型糖尿病患者聽力損傷的風(fēng)險。尿微量白蛋白/肌酐比值、糖尿病病程、糖化血紅蛋白、低密度脂蛋白及糖尿病視網(wǎng)膜病變與前庭功能損傷有相關(guān)關(guān)系,可以增加2型糖尿病前庭功能損傷的風(fēng)險。4.現(xiàn)在社會對糖尿病腎病警惕性高并能進(jìn)行早期篩查,而對糖尿病聽力損害及前庭功能損害警惕性低,出現(xiàn)微量蛋白尿時,提示糖尿病腎病病人可能已經(jīng)有早期耳蝸-前庭功能損傷,為早期診斷提供可能,為進(jìn)一步預(yù)防治療提供依據(jù),可以明顯提高患者生活質(zhì)量。
[Abstract]:Background and objective: diabetes mellitus is a common endocrine metabolic chronic disease, can be complicated with cardio vascular and retina, kidney, peripheral nerve microangiopathy, and these complications will greatly affect the quality of life of patients. In recent years, more and more research on diabetes and inner ear, has been demonstrated in diabetic patients than in nondiabetic patients the incidence of hearing impairment was obviously increased. The current study found that diabetes caused hearing loss showed bilateral progressive sensorineural hearing loss in high frequency. But first, the pathogenesis of diabetic hearing impairment has not been entirely clear, the possible mechanism for loss of outer hair cells, vascular wall thickening, spiral ganglion neurons atrophy and electrolyte disorder. Some evidence suggests that the inner ear and kidney are similar, especially in anatomy and physiology. Observed under the electron microscope, the inner ear vasculature and the kidney glomeruli are closely related with the micro vascular epithelial structure. There are a lot of important diabetic microvascular complications, and the purpose of this study was to evaluate with or without diabetes nephropathy in diabetic patients to vestibular dysfunction, and explore the relationship between clinical indexes and vestibular patients with diabetes hearing impairment. Methods: first groups: NC group (15 male, 15 female, 60 ears) for healthy people, patients with type.2 diabetes as a control group of 60 people, and according to urinary albumin / creatinine ratio (ACR) were divided into two groups. Second groups: DM group (15 male, 15 female, 60 ears) for diabetic patients without diabetes nephropathy, third group: DN group (14 male, 16 female, 60 ears) for diabetic patients with diabetic nephropathy. The duration of diabetes, the statistics of each were blood pressure, BMI, waist circumference, C peptide, insulin, serum creatinine, urea nitrogen, glomerular Filtration rate, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, glycosylated hemoglobin, uric acid, fundus photography, nerve conduction and carotid artery ultrasonography. And to detect three groups of subjects pure tone audiometry, acoustic emission, video electronystagmography, myogenic potential of cold and hot water test and vestibular evoked respectively. For the three groups of subjects of hearing and vestibular function results in statistics, and to observe the correlation between clinical indexes and inner ear damage. All data were analyzed using SPSS21.0. Results: 1.. Clinical observation index results table 1 shows, two groups of patients with diabetes mellitus HbA1c, fasting blood glucose, systolic blood pressure, waist hip ratio, triglyceride, total cholesterol, low density lipoprotein, high density lipoprotein and uric acid levels were significantly higher than the healthy group (P0.05). In addition, DM group, BMI, waist circumference and homocysteine level and NC group in Ming Dynasty Significant statistical difference (P0.05) of.DM group and DN group, the level of homocysteine and cystatin C had significant difference (P0.05), creatinine, urea nitrogen, there was no significant difference in glomerular filtration rate (P0.05) in the.DM group 7 (23.33%) patients with fundus lesions, 8 (26.67%) patients had peripheral nerve lesions, 12 (40%) patients with carotid artery ultrasound abnormalities in the.DN group 27 (90%) patients with fundus lesions, 23 (76.67%) patients with peripheral neuropathy, 27 (90%) patients with carotid artery ultrasound abnormalities. Two groups of diabetic patients had statistically significant difference (P0.05 2.) the results of pure tone audiometry we can see from Figure 1, the two groups of left ear in patients with diabetes mellitus (5001000200040008000Hz) and right (5001000200040008000Hz) had significant difference with NC group (P0.05), and DN group than in DM group the left ear hearing loss of 2508000Hz and 8000Hz at the right ear is more serious (P0.05). No significant difference between the two ears (P0.05) blood glycosylated. Red protein, waist circumference, urinary albumin / creatinine ratio and glomerular filtration rate and hearing loss are related to.3. otoacoustic emission is shown by Figure 2, patients in group DN (4kHz) in the left ear and the right ear (0.75,2,4kHz) and the NC group were significantly different (P0.05).DM group in the right ear 0.75kHz, there were significant differences in 4kHz with the NC group (P0.05). There were no difference between the two ears (P0.05).4. video electronystagmography and hot and cold water test table 2 shows, video electronystagmography results in three groups were normal. Hot and cold water test results, 5 people in the DM group showed vestibular dysfunction, 9 group DN is in the form of vestibular dysfunction. But no significant difference between two groups (P0.05). Glycated hemoglobin and urine albumin / creatinine ratio and vestibular function injury myogenic potential NC correlation between.5. vestibular evoked group 2 (6.67%) did not elicit ear amplitude, 1 (3.33%) did not elicit left ear amplitude; DM group 3 (1 0%) did not elicit ear amplitude, 1 (3.33%) did not elicit left ear amplitude, 2 (6.67%) ears were not drawn amplitude; DN group of 5 people (16.67%) did not elicit ear amplitude, 2 (6.67%) did not elicit left ear amplitude, 3 (10%) ears were not drawn by the amplitude. Table 3 shows that two groups of diabetic group left ear and the right ear amplitude and the health of people than there were statistically significant differences (P0.05), but there were no significant differences between DM group and DN group, two ears). Amplitude (P0.05) from table 5, table 6 shows that the VEMPs amplitude decreased with the duration of diabetes, HbA1c, correlation between lipoprotein and the diabetic retinopathy and the vestibular function of low density injury. Conclusion: 1. diabetic patients than in nondiabetic patients the incidence of hearing loss was high, showed bilateral progressive sensorineural hearing loss, and with a high frequency. In patients with diabetic nephropathy compared with patients with diabetic renal disease with high incidence,.2. hearing injury Now earlier, vestibular damage appeared later. That inner ear damage is a gradual process, with hearing impairment patients prone to vestibular function damage.3. HbA1c, waist circumference, urinary albumin / creatinine and glomerular filtration rate and the relationship with hearing impairment, can increase the risk of type 2 diabetes mellitus patients with hearing damage the urine albumin / creatinine ratio, duration of diabetes, HbA1c, correlation between lipoprotein and diabetic retinopathy and vestibular function of low density damage, can increase the vestibular function injury of type 2 diabetes risk.4. now society on diabetic nephropathy high vigilance and early screening for diabetes, hearing impairment and vestibular function the damage of low vigilance, microalbuminuria, have early cochlear and vestibular functions may indicate injury in patients with diabetic nephropathy, as early The diagnosis provides the possibility, provides the basis for further prevention and treatment, and can obviously improve the quality of life of the patients.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2;R692.9;R764

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