2型糖尿病患者腎損傷程度與聽力損害的關(guān)系研究
發(fā)布時間：2018-08-16 07:51
【摘要】：研究目的:糖尿病是一組以高血糖為特征的代謝性疾病,表現(xiàn)為慢性高血糖、蛋白質(zhì)及脂肪代謝紊亂,可引起多器官損害和功能障礙,導(dǎo)致一系列的臨床并發(fā)癥,包括心腦血管的大血管病變和微血管病變。其中由糖尿病引起的腎損傷是糖尿病病人最重要的并發(fā)癥之一,研究發(fā)現(xiàn)早期糖尿病患者即可出現(xiàn)尿微量白蛋白。同時,糖尿病患者聽力下降的現(xiàn)像近年來受到了越來越多的關(guān)注,相關(guān)研究逐漸增多。但是有關(guān)糖尿病患者腎損傷與聽力下降的關(guān)系研究甚少,本研究旨在探討2型糖尿病(T2DM)患者合并不同程度白蛋白尿時聽力功能的改變,并討論T2DM患者基本臨床指標變化與聽力損害的關(guān)系,包括尿微量白蛋白(U-MA)、糖化血紅蛋白AlC(HbAlC)、尿素氮(BUN)、血肌酐(Cr)、甘油三酯(TG)、膽固醇(Chol)、低/高密度脂蛋白(LDL-C/HDL-C)、同型半胱氨酸(Hcy)、胱抑素C(Cys-C)及尿酸(UA)等,為糖尿病腎損傷與聽力損害的關(guān)系提供理論依據(jù)。研究方法:收集2型糖尿病合并尿微量白蛋白(T2DM早期腎病期組)、糖尿病合并臨床白蛋白尿患者(T2DM臨床腎病期組)各30例及健康正常人20例分別進行性別、年齡、體重指數(shù)(BMI)、腰臀比、尿微量白蛋白(U-MA)、尿蛋白、糖化血紅蛋白A1C(HbAlC)、尿素氮(BUN)、血肌酐(Cr)、膽固醇(Chol)、甘油三酯(TG)、低/高密度脂蛋白(LDL-C/HDL-C)、同型半胱氨酸(Hcy)、胱抑素C(Cys-C)、尿酸(UA)、眼底及神經(jīng)傳導(dǎo)檢查測定等基本臨床指標的檢測和記錄。對T2DM早期腎病期組、T2DM臨床腎病期組及健康對照組患者分別進行純音測聽、聽覺腦干反應(yīng)、耳聲發(fā)射及耳蝸電圖檢測,研究兩組不同程度腎臟損害糖尿病患者聽力功能狀況及聽力損害定位。依據(jù)純音測聽、聽覺腦干反應(yīng)、耳聲發(fā)射及耳蝸電圖檢測結(jié)果探討T2DM早期腎病期組、T2DM臨床腎病期組各臨床指標與聽覺系統(tǒng)各部分損害的關(guān)系。研究結(jié)果:1.臨床基本指標觀察結(jié)果對照組、T2DM早期腎病組和T2DM臨床腎病組之間BMI、U-MA、HbAlC、BUN、Cr、Hcy、Cys-C及UA等指標均有統(tǒng)計學(xué)差異(*P0.05),而TG、CHOL、LDL-C和HDL-C等指標未見顯著性統(tǒng)計學(xué)差異(P0.05);與對照組比較,T2DM早期腎病組和臨床腎病組的BMI、U-MA、HbAlC、Cr、Hcy等指標均顯著升高,T2DM臨床腎病組的BUN、Cys-C及UA顯著高于對照組(*P0.05),而T2DM早期腎病組的BUN、Cys-C及UA較對照組雖然有所上升但是未見統(tǒng)計學(xué)差異(P0.05)。另外,與T2DM早期腎病組相比較,T2DM臨床腎病組中BUN、Cr、Hcy、Cys-C和UA顯著升高(#P0.05)。2.視網(wǎng)膜病變和周圍神經(jīng)病變結(jié)果分析視網(wǎng)膜病變檢測結(jié)果發(fā)現(xiàn)健康對照組視網(wǎng)膜正常者占19/20,僅1例雙眼見病變(1/20),未見單眼病變(0/20);T2DM早期腎病組視網(wǎng)膜正常者占15/30,3例單眼見病變(3/30),12例雙眼見病變(12/30);T2DM臨床腎病組視網(wǎng)膜正常者占11/30,1例單眼見病變(1/30),18例雙眼見病變(18/30)。周圍神經(jīng)病變結(jié)果發(fā)現(xiàn)各組神經(jīng)傳導(dǎo)減慢者所占比例分別為健康對照組15%,T2DM早期腎病組40%,而T2DM臨床腎病組70%,包括左右正中神經(jīng)傳導(dǎo)減慢、左右脛減慢、雙側(cè)減慢等情況。3.純音測聽結(jié)果與對照組相比較,低頻條件下(250 Hz和500 Hz),T2DM早期腎病組和T2DM臨床腎病組左耳和右耳的測聽結(jié)果均未見顯著改變;但是從1000 Hz開始,T2DM早期腎病組和T2DM臨床腎病組左耳和右耳的聽閾結(jié)果均顯著升高(*P0.05),提示糖尿病患者中高頻有聽力損失。至8000Hz時,對照組、T2DM早期腎病組和T2DM臨床腎病組左耳的聽閾分別為(15.25±3.34)dB、(32.33±8.57)dB和(46.33±6.79)dB,右耳的聽閾分別為(11.8±2.93)dB、(29.5±7.34)dB和(47.17±6.15)dB。同時,從1000Hz開始,T2DM臨床腎病組患者左耳和右耳的聽閾值均顯著高于T2DM早期腎病組(#P0.05),提示腎損傷程度重的患者高頻聽力損害加重。4.ABR檢測結(jié)果T2DM組左耳和右耳Ⅰ波、Ⅲ波、Ⅴ波及潛伏間期Ⅰ—Ⅲ、Ⅲ—Ⅴ、Ⅰ—Ⅴ相較于對照組均明顯延遲,差異具有統(tǒng)計學(xué)意義(*P0.05)。進一步對比T2DM早期腎病組及T2DM臨床腎病組患者左耳和右耳的ABR測試結(jié)果,發(fā)現(xiàn)T2DM臨床腎病組患者左耳在潛伏間期Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ較T2DM早期腎病組左耳顯著延遲(#P0.05),右耳在潛伏期III波、V波及潛伏間期Ⅰ-Ⅲ、Ⅰ-Ⅴ較T2DM早期腎病組右耳顯著延遲(#P0.05)。T2DM臨床腎病組患者左耳和右耳在V波潛伏期延遲,其中左耳V波潛伏期為(6.2±0.42)ms,右耳V波潛伏期為(6.24±0.40)ms。5.DPOAE檢測結(jié)果對照組、T2DM早期腎病組、T2DM臨床腎病組三組在各個頻率下(0.5,0.75,1.0,1.4,2.0,3.0,4.0,6.0,8.0kHz)左耳和右耳聽力異常者所占的百分比大小依次是T2DM臨床腎病組T2DM早期腎病組對照組;尤其在中高頻時(1.0-4.0 kHz),各組間的差值最大;提示糖尿病患者中高頻時(1.0-4.0kHz)的外毛細胞功能損傷最嚴重,且隨著腎臟損傷程度的加重,外毛細胞功能損傷逐漸加重,以中高頻時(1.0-4.0kHz)加重最明顯。6.耳蝸電圖(ECochG)結(jié)果分析以SP/AP0.4為結(jié)果正常,SP/AP≥0.4為結(jié)果異常比較健康對照組、T2DM早期腎病組、T2DM臨床腎病組患者左耳和右耳聽力情況。結(jié)果顯示,左耳聽力異常比例為健康對照15%、T2DM早期腎病組53.33%、T2DM臨床腎病組86.67%;右耳聽力異常比例為健康對照20%、T2DM早期腎病組50%、T2DM臨床腎病組86.67%。提示隨著糖尿病患者腎臟損傷程度的加重,耳蝸電圖檢測結(jié)果正常的左右耳比例明顯下降,異常比例值明顯升高。研究結(jié)論:1、T2DM 伴腎損傷患者 BMI、U-MA、HbAlC、Cr、Hcy、BUN、Cys-C 及 UA等指標均顯著升高,尤其是BUN、Cys-C及UA升高最顯著,且視網(wǎng)膜病變和周圍神經(jīng)病變明顯加重,提示更嚴重的腎損傷。2、T2DM伴腎損傷患者聽力損失主要表現(xiàn)為中高頻的聽閾升高,且在高頻條件下(4000-8000 Hz)聽力損失的程度隨著腎臟損傷程度的加重而加重。3、T2DM伴腎損傷患者中高頻時(1000-4000 kHz)外毛細胞功能損傷較嚴重,且外毛細胞功能損傷程度隨著腎臟損傷程度的加重而加重。4、T2DM伴腎損傷患者高頻條件下(4000-8000Hz)多伴有耳蝸內(nèi)積水,這可能是高頻條件下T2DM伴腎損傷患者聽力損失加重的原因之一。5、年齡、BMI、HbAlC、Cr、UA、Hcy/TG、CHOL 和 LDL-C 等指標是 T2DM伴腎損傷患者聽力損害的風險預(yù)測因素。
[Abstract]:Objective: Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia, characterized by chronic hyperglycemia, disorders of protein and fat metabolism, which can cause multiple organ damage and dysfunction, leading to a series of clinical complications, including cardiovascular and cerebrovascular disease and microvascular disease. Among them, diabetic renal injury is caused by glucose. Microalbuminuria is one of the most important complications in patients with diabetes mellitus. At the same time, the phenomenon of hearing loss in diabetic patients has attracted more and more attention in recent years. To investigate the changes of hearing function in patients with type 2 diabetes mellitus (T2DM) complicated with different degrees of albuminuria, and to discuss the relationship between the changes of basic clinical indicators and hearing impairment, including urinary microalbumin (U-MA), glycosylated hemoglobin AlC (HbAlC), urea nitrogen (BUN), serum creatinine (Cr), triglyceride (TG), cholesterol (Chol), low/high density lipid eggs. White (LDL-C/HDL-C), homocysteine (Hcy), cystatin C (Cys-C) and uric acid (UA) provide theoretical basis for the relationship between diabetic nephropathy and hearing impairment. Methods: 30 patients with type 2 diabetes mellitus complicated with urinary microalbumin (early nephropathy group of T2DM), 30 patients with diabetes mellitus complicated with clinical albuminuria (clinical nephropathy group of T2DM) and 30 patients with healthy. 20 healthy people were divided into sex, age, body mass index (BMI), waist-hip ratio, urinary microalbumin (U-MA), urinary protein, glycosylated hemoglobin A1C (HbAlC), urea nitrogen (BUN), serum creatinine (Cr), cholesterol (Chol), triglyceride (TG), low/high density lipoprotein (LDL-C/HDL-C), homocysteine (Hcy), cystatin C (Cys-C), uric acid (UA), fundus and spirit. The patients in early stage of T2DM nephropathy, clinical stage of T2DM nephropathy and healthy control group were examined by pure tone audiometry, auditory brainstem response, otoacoustic emission and cochlear electrogram respectively. Objective:To investigate the relationship between the clinical parameters and the impairment of auditory system in early stage of T2DM nephropathy and clinical stage of T2DM nephropathy according to the results of pure tone audiometry, auditory brainstem response, otoacoustic emission and electrocochlear electrogram. BMI, U-MA, HbAlC, Cr, Hcy, Cys-C and UA in early stage of T2DM nephropathy group and clinical nephropathy group were significantly higher than those in control group (P 0.05). * P 0.05), while BUN, Cys-C and UA in the early stage of T2DM nephropathy group were higher than those in the control group, but there was no significant difference (P 0.05). In addition, BUN, Cr, Hcy, Cys-C and UA in the early stage of T2DM nephropathy group were significantly higher than those in the early stage of T2DM nephropathy group (#P 0.05). 2. Retinopathy and peripheral neuropathy results analysis of retinopathy detection showed that In healthy control group, 19/20 had normal retina, only 1 case had binocular lesion (1/20), and no single eye lesion (0/20); 15/30 had normal retina in early stage of T2DM, 3 had monocular lesion (3/30), 12 had binocular lesion (12/30); 11/30 had normal retina in clinical stage of T2DM, 1 had monocular lesion (1/30) and 18 had binocular lesion (18/30). The results of peripheral neuropathy showed that 15% of the patients in the healthy control group, 40% in the early stage of T2DM nephropathy group, and 70% in the T2DM clinical nephropathy group, including the slow conduction of left and right median nerves, the slow tibia, bilateral slowdown and so on. There was no significant change in left and right ear audiometry in early renal disease group and T2DM clinical nephropathy group, but from 1000 Hz, the left and right ear audiometry in early renal disease group and T2DM clinical nephropathy group increased significantly (*P 0.05), suggesting that high-frequency hearing loss occurred in patients with diabetes mellitus. The auditory thresholds of the left ear were (15.25+3.34) dB, (32.33+8.57) dB, and (46.33+6.79) dB in the 2DM clinical nephropathy group, respectively. The auditory thresholds of the right ear were (11.8+2.93) dB, (29.5+7.34) dB and (47.17+6.15) dB in the T2DM clinical nephropathy group were significantly higher than those in the T2DM early nephropathy group (#P 0.05), suggesting that the auditory thresholds of the left ear and right ear were significantly higher than those in the T2DM early nephropathy group (#P High-frequency hearing impairment was aggravated in severe patients. 4. ABR test results showed that the left and right ear I, III, V wave and latency I-III, III-V, I-V of T2DM group were significantly delayed compared with the control group, the difference was statistically significant (*P 0.05). Further compared with T2DM early nephropathy group and T2DM clinical nephropathy group, ABR of left and right ear were significantly delayed. The results showed that the latency of left ear in T2DM group was significantly delayed (#P 0.05) and that of right ear was significantly delayed (#P 0.05) in the latency phase III wave, V wave and latency phase I-III, I-V wave compared with the right ear in T2DM group (#P 0.05). The latency of left ear and right ear in T2DM group was significantly delayed (#P 0.05). The latency of V wave in left ear was (6.2.42) ms, and that in right ear was (6.24.40) Ms. The difference between the two groups was the greatest, especially in the middle and high frequency (1.0-4.0 kHz), suggesting that the function damage of outer hair cells was the most serious in the middle and high frequency (1.0-4.0 kHz) of diabetes mellitus patients, and with the aggravation of kidney injury, the function damage of outer hair cells was gradually aggravated, especially in the middle and high frequency (1.0-4.0 kHz). The results of electrocochleogram (ECochG) analysis showed that SP/AP 0.4 was normal, SP/AP (>0.4) was abnormal in healthy control group, T2DM early nephropathy group, T2DM clinical nephropathy group, left and right ear hearing. The results showed that the proportion of abnormal left ear hearing was 15% in healthy control group, 53.33% in T2DM early nephropathy group, 86.67% in T2DM clinical nephropathy group. The abnormal ratio was 20% in the healthy control group, 50% in the early stage of T2DM nephropathy group and 86.67% in the T2DM clinical nephropathy group. UA and other indicators were significantly increased, especially BUN, Cys-C and UA, and retinopathy and peripheral neuropathy were significantly aggravated, suggesting more serious kidney injury. 2, T2DM patients with kidney injury hearing loss is mainly manifested in high-frequency hearing threshold increased, and in high-frequency conditions (4000-8000Hz) hearing loss with the extent of kidney damage. External hair cell function damage was more serious in T2DM patients with kidney injury at high frequency (1000-4000 kHz), and the degree of external hair cell function damage was aggravated with the aggravation of kidney injury. 4. In T2DM patients with kidney injury at high frequency (4000-8000 Hz), cochlear hydrocele was more common, which may be T2DM patients with kidney injury at high frequency. Age, BMI, HbAlC, Cr, UA, Hcy/TG, CHOL and LDL-C are risk factors for hearing loss in T2DM patients with kidney injury.
【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
[Abstract]:Objective: Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia, characterized by chronic hyperglycemia, disorders of protein and fat metabolism, which can cause multiple organ damage and dysfunction, leading to a series of clinical complications, including cardiovascular and cerebrovascular disease and microvascular disease. Among them, diabetic renal injury is caused by glucose. Microalbuminuria is one of the most important complications in patients with diabetes mellitus. At the same time, the phenomenon of hearing loss in diabetic patients has attracted more and more attention in recent years. To investigate the changes of hearing function in patients with type 2 diabetes mellitus (T2DM) complicated with different degrees of albuminuria, and to discuss the relationship between the changes of basic clinical indicators and hearing impairment, including urinary microalbumin (U-MA), glycosylated hemoglobin AlC (HbAlC), urea nitrogen (BUN), serum creatinine (Cr), triglyceride (TG), cholesterol (Chol), low/high density lipid eggs. White (LDL-C/HDL-C), homocysteine (Hcy), cystatin C (Cys-C) and uric acid (UA) provide theoretical basis for the relationship between diabetic nephropathy and hearing impairment. Methods: 30 patients with type 2 diabetes mellitus complicated with urinary microalbumin (early nephropathy group of T2DM), 30 patients with diabetes mellitus complicated with clinical albuminuria (clinical nephropathy group of T2DM) and 30 patients with healthy. 20 healthy people were divided into sex, age, body mass index (BMI), waist-hip ratio, urinary microalbumin (U-MA), urinary protein, glycosylated hemoglobin A1C (HbAlC), urea nitrogen (BUN), serum creatinine (Cr), cholesterol (Chol), triglyceride (TG), low/high density lipoprotein (LDL-C/HDL-C), homocysteine (Hcy), cystatin C (Cys-C), uric acid (UA), fundus and spirit. The patients in early stage of T2DM nephropathy, clinical stage of T2DM nephropathy and healthy control group were examined by pure tone audiometry, auditory brainstem response, otoacoustic emission and cochlear electrogram respectively. Objective:To investigate the relationship between the clinical parameters and the impairment of auditory system in early stage of T2DM nephropathy and clinical stage of T2DM nephropathy according to the results of pure tone audiometry, auditory brainstem response, otoacoustic emission and electrocochlear electrogram. BMI, U-MA, HbAlC, Cr, Hcy, Cys-C and UA in early stage of T2DM nephropathy group and clinical nephropathy group were significantly higher than those in control group (P 0.05). * P 0.05), while BUN, Cys-C and UA in the early stage of T2DM nephropathy group were higher than those in the control group, but there was no significant difference (P 0.05). In addition, BUN, Cr, Hcy, Cys-C and UA in the early stage of T2DM nephropathy group were significantly higher than those in the early stage of T2DM nephropathy group (#P 0.05). 2. Retinopathy and peripheral neuropathy results analysis of retinopathy detection showed that In healthy control group, 19/20 had normal retina, only 1 case had binocular lesion (1/20), and no single eye lesion (0/20); 15/30 had normal retina in early stage of T2DM, 3 had monocular lesion (3/30), 12 had binocular lesion (12/30); 11/30 had normal retina in clinical stage of T2DM, 1 had monocular lesion (1/30) and 18 had binocular lesion (18/30). The results of peripheral neuropathy showed that 15% of the patients in the healthy control group, 40% in the early stage of T2DM nephropathy group, and 70% in the T2DM clinical nephropathy group, including the slow conduction of left and right median nerves, the slow tibia, bilateral slowdown and so on. There was no significant change in left and right ear audiometry in early renal disease group and T2DM clinical nephropathy group, but from 1000 Hz, the left and right ear audiometry in early renal disease group and T2DM clinical nephropathy group increased significantly (*P 0.05), suggesting that high-frequency hearing loss occurred in patients with diabetes mellitus. The auditory thresholds of the left ear were (15.25+3.34) dB, (32.33+8.57) dB, and (46.33+6.79) dB in the 2DM clinical nephropathy group, respectively. The auditory thresholds of the right ear were (11.8+2.93) dB, (29.5+7.34) dB and (47.17+6.15) dB in the T2DM clinical nephropathy group were significantly higher than those in the T2DM early nephropathy group (#P 0.05), suggesting that the auditory thresholds of the left ear and right ear were significantly higher than those in the T2DM early nephropathy group (#P High-frequency hearing impairment was aggravated in severe patients. 4. ABR test results showed that the left and right ear I, III, V wave and latency I-III, III-V, I-V of T2DM group were significantly delayed compared with the control group, the difference was statistically significant (*P 0.05). Further compared with T2DM early nephropathy group and T2DM clinical nephropathy group, ABR of left and right ear were significantly delayed. The results showed that the latency of left ear in T2DM group was significantly delayed (#P 0.05) and that of right ear was significantly delayed (#P 0.05) in the latency phase III wave, V wave and latency phase I-III, I-V wave compared with the right ear in T2DM group (#P 0.05). The latency of left ear and right ear in T2DM group was significantly delayed (#P 0.05). The latency of V wave in left ear was (6.2.42) ms, and that in right ear was (6.24.40) Ms. The difference between the two groups was the greatest, especially in the middle and high frequency (1.0-4.0 kHz), suggesting that the function damage of outer hair cells was the most serious in the middle and high frequency (1.0-4.0 kHz) of diabetes mellitus patients, and with the aggravation of kidney injury, the function damage of outer hair cells was gradually aggravated, especially in the middle and high frequency (1.0-4.0 kHz). The results of electrocochleogram (ECochG) analysis showed that SP/AP 0.4 was normal, SP/AP (>0.4) was abnormal in healthy control group, T2DM early nephropathy group, T2DM clinical nephropathy group, left and right ear hearing. The results showed that the proportion of abnormal left ear hearing was 15% in healthy control group, 53.33% in T2DM early nephropathy group, 86.67% in T2DM clinical nephropathy group. The abnormal ratio was 20% in the healthy control group, 50% in the early stage of T2DM nephropathy group and 86.67% in the T2DM clinical nephropathy group. UA and other indicators were significantly increased, especially BUN, Cys-C and UA, and retinopathy and peripheral neuropathy were significantly aggravated, suggesting more serious kidney injury. 2, T2DM patients with kidney injury hearing loss is mainly manifested in high-frequency hearing threshold increased, and in high-frequency conditions (4000-8000Hz) hearing loss with the extent of kidney damage. External hair cell function damage was more serious in T2DM patients with kidney injury at high frequency (1000-4000 kHz), and the degree of external hair cell function damage was aggravated with the aggravation of kidney injury. 4. In T2DM patients with kidney injury at high frequency (4000-8000 Hz), cochlear hydrocele was more common, which may be T2DM patients with kidney injury at high frequency. Age, BMI, HbAlC, Cr, UA, Hcy/TG, CHOL and LDL-C are risk factors for hearing loss in T2DM patients with kidney injury.
【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
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