2型糖尿病性周圍神經(jīng)病變與聽力損傷相關(guān)性研究
發(fā)布時間：2019-07-10 10:42
【摘要】：目的:本研究應(yīng)用純音聽閾(Pure Tone Audiometry,PTA)與畸變產(chǎn)物耳聲發(fā)射(Distortion Product Otoacoustic Emission,DPOAE)檢測糖尿病及周圍神經(jīng)病變患者患者的聽力及耳蝸外毛細(xì)胞功能,從而探討糖尿病周圍神經(jīng)病變(Diabetic Peripheral Neuropathy,DPN)與聽力減退的關(guān)系,并行糖尿病及周圍神經(jīng)病變患者聽力減退的相關(guān)因素分析。為糖尿病及周圍神經(jīng)病變患者聽力受損的早期篩查和干預(yù)提供依據(jù)。方法:1、連續(xù)收集2016年2月至2017年1月在南昌大學(xué)第二附屬醫(yī)院內(nèi)分泌與代謝科住院的2型糖尿病(Type 2 Diabetes Mellitus,T2DM)患者70例作為實(shí)驗(yàn)組;根據(jù)有無周圍神經(jīng)病變,實(shí)驗(yàn)組分為DPN組(35例)和非DPN組(35例);另從南昌大學(xué)第二附屬醫(yī)院體檢科隨機(jī)入選34例受試者為健康對照組。2、對104例研究對象均行神經(jīng)傳導(dǎo)速度(Nerve Conduction Velocity,NCV)、PTA、DPOAE檢查。比較3組的一般資料、臨床資料及血清學(xué)指標(biāo);比較3組間的PTA和DPOAE幅值結(jié)果;對PTA正常的研究對象行DPOAE幅值比較;分析DPN嚴(yán)重程度與聽力減退程度的相關(guān)性;行糖尿病聽力減退的危險因素分析。結(jié)果:1、DPN組、非DPN組的糖化血紅蛋白(HbA1c)、空腹血糖(FBG)、甘油三脂(TG)、膽固醇(TC)、餐后血糖(PBG)、低密度脂蛋白(LDL-C)、尿微量白蛋白(UM-Alb)等指標(biāo)與健康對照組差異有統(tǒng)計(jì)學(xué)意義(均P0.05),但DPN組與非DPN組無差異(P0.05)。2、PTA結(jié)果比較:DPN組聽力正常19例,輕度減退10例,中度減退5例,重度減退1例,極重度減退0例;非DPN組聽力正常27例,輕度減退8例,中度減退0例,重度減退0例,極重度減退0例;健康對照組聽力均正常。DPN組在0.5KHz、1.0KHz、2.0KHz、4.0KHz所有頻率的聽閾值均高于非DPN組及健康對照組(均P0.05),非DPN組僅在4.0KHz頻率中的聽閾值高于健康對照組(P0.05)。3、DPOAE幅值結(jié)果比較:DPN組DPOAE幅值在0.5KHz、1.0KHz、2.0KHz、4.0KHz、8.0KHz等頻率中均低于非DPN組和健康對照組(均P0.05);非DPN組DPOAE幅值僅在4.0KHz、8.0KHz頻率較健康對照組低(p0.05)。4、對三組中PTA結(jié)果正常的對象行DPOAE幅值比較,即DPN組19例,非DPN組27例,健康對照組34例。結(jié)果顯示DPN組DPOAE幅值在0.5KHz、1.0KHz、2.0KHz、4.0KHz、8.0KHz等頻率中均低于健康對照組(P0.01),在0.5 KHz、1.0 KHz、2.0 KHz、4.0 KHz頻率較非DPN組低(P0.01);非DPN組DPOAE幅值在8.0KHz頻率低于健康對照組(P0.01)。5、Spearman相關(guān)分析顯示DPN嚴(yán)重程度與聽力減退程度呈正相關(guān)(Spearman相關(guān)系數(shù)=0.753)。6、多因素逐步Logistic回歸分析得出病程(回歸系數(shù)=0.195,P=0.013)、糖化血紅蛋白(回歸系數(shù)=0.205,P=0.001)是聽力減退的獨(dú)立危險因素。結(jié)論:1、2型糖尿病患者聽力減退一般表現(xiàn)為輕中度,多為高頻聽力受損;糖尿病周圍神經(jīng)病變患者常更易合并聽力減退,低中高頻聽力均易受損。2、2型糖尿病患者病程長、高血糖可能更易合并聽力損害,糖尿病患者應(yīng)積極控制血糖,在糖尿病早期就應(yīng)重視對聽力的監(jiān)測,尤其是合并了周圍神經(jīng)病變的患者。3、畸變產(chǎn)物耳聲發(fā)射可用于評價聽力正常的2型糖尿病及周圍神經(jīng)病變患者的早期耳蝸損害。
[Abstract]:Objective: To study the effects of pure tone audiometry (PTA) and distortion product otoacoustic emission (DPOAE) on the hearing of patients with diabetes and peripheral neuropathy and the function of the outer hair cells of the cochlea. The relationship between DPN and hypohearing, and the related factors of hearing loss in patients with parallel diabetes and peripheral neuropathy. To provide the basis for early screening and intervention of hearing impairment in patients with diabetes and peripheral neuropathy. Methods:1.70 cases of type 2 diabetes (Type 2 Diabetes Mellitus, T2DM) in the second affiliated hospital of Nanchang University from February 2016 to January 2017 were collected as experimental group. According to the presence or absence of peripheral neuropathy, The experimental group was divided into DPN group (35 cases) and non-DPN group (35 cases), and 34 subjects were randomly selected from the second Affiliated Hospital of Nanchang University as the healthy control group, and the nerve conduction velocity (NCV), PTA and DPOAE were examined in 104 subjects. The general data, clinical data and serological markers of the 3 groups were compared; the results of the amplitude of PTA and DPOAE between the three groups were compared; the amplitude of the DPOAE was compared with the normal subjects of PTA; the correlation between the severity of the DPN and the degree of hearing loss was analyzed; and the risk factors of hearing loss in the line of diabetes were analyzed. Results: The glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), triglyceride (TG), cholesterol (TC), postprandial blood glucose (PBG) and low density lipoprotein (LDL-C) in the DPN group, non-DPN group, There was no difference between the indexes of urine microalbumin (UM-Alb) and the healthy control group (P <0.05), but there was no difference between the DPN group and the non-DPN group (P0.05). In the non-DPN group, the hearing was normal in 27, mild in 8, moderate in 0, severe in 0, and severe in 0; and the hearing of the healthy control group was normal. The hearing threshold of DPN group at 0.5KHz, 1.0KHz, 2.0KHz and 4.0KHz was higher than that of the non-DPN group and the healthy control group (P0.05). The hearing threshold of the non-DPN group only in the frequency of 4.0 KHz was higher than that of the healthy control group (P0.05). The amplitude of DPOAE in the non-DPN group was only 4.0 KHz and the frequency of 8.0 KHz was lower than that of the healthy control group (p0.05).4. The amplitude of the DPOAE in the normal subjects in the three groups was compared, that is,19 patients in the DPN group,27 in the non-DPN group and 34 in the healthy control group. The results showed that the amplitude of DPOAE in DPN group was lower than that of healthy control group (P 0.01) at the frequency of 0.5 KHz, 1.0 KHz, 2.0 KHz, 4.0 KHz, and 8.0 KHz (P0.01). The frequency of DPOAE in the non-DPN group was lower than that of the healthy control group (P0.01). The frequency of DPOAE in the non-DPN group was lower than that of the healthy control group (P0.01). Spearman correlation analysis showed that the severity of DPN was positively correlated with the degree of hearing loss (Spearman correlation coefficient = 0.753).6. The multi-factor step-by-step logistic regression analysis results in the course of disease (regression coefficient = 0.195, P = 0.013), and the glycosylated hemoglobin (regression coefficient = 0.205, P = 0.001) is an independent risk factor for hearing loss. Conclusion:1. The hearing loss of type 2 diabetic patients is usually mild and moderate, most of them are high-frequency hearing impairment; the patients with diabetic peripheral neuropathy are often more likely to be combined with hearing loss, and the low-middle-high-frequency hearing is impaired.2. The course of the patients with type 2 diabetes is long, and the hyperglycemia may be more likely to be combined with hearing impairment. The patients with diabetes should actively control the blood sugar, and should pay more attention to the monitoring of the hearing in the early stage of diabetes, especially those with peripheral neuropathy.3. The otoacoustic emission of the distorted product can be used to evaluate the early cochlear damage in patients with type 2 diabetes and peripheral neuropathy.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2
本文編號：2512551
[Abstract]:Objective: To study the effects of pure tone audiometry (PTA) and distortion product otoacoustic emission (DPOAE) on the hearing of patients with diabetes and peripheral neuropathy and the function of the outer hair cells of the cochlea. The relationship between DPN and hypohearing, and the related factors of hearing loss in patients with parallel diabetes and peripheral neuropathy. To provide the basis for early screening and intervention of hearing impairment in patients with diabetes and peripheral neuropathy. Methods:1.70 cases of type 2 diabetes (Type 2 Diabetes Mellitus, T2DM) in the second affiliated hospital of Nanchang University from February 2016 to January 2017 were collected as experimental group. According to the presence or absence of peripheral neuropathy, The experimental group was divided into DPN group (35 cases) and non-DPN group (35 cases), and 34 subjects were randomly selected from the second Affiliated Hospital of Nanchang University as the healthy control group, and the nerve conduction velocity (NCV), PTA and DPOAE were examined in 104 subjects. The general data, clinical data and serological markers of the 3 groups were compared; the results of the amplitude of PTA and DPOAE between the three groups were compared; the amplitude of the DPOAE was compared with the normal subjects of PTA; the correlation between the severity of the DPN and the degree of hearing loss was analyzed; and the risk factors of hearing loss in the line of diabetes were analyzed. Results: The glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), triglyceride (TG), cholesterol (TC), postprandial blood glucose (PBG) and low density lipoprotein (LDL-C) in the DPN group, non-DPN group, There was no difference between the indexes of urine microalbumin (UM-Alb) and the healthy control group (P <0.05), but there was no difference between the DPN group and the non-DPN group (P0.05). In the non-DPN group, the hearing was normal in 27, mild in 8, moderate in 0, severe in 0, and severe in 0; and the hearing of the healthy control group was normal. The hearing threshold of DPN group at 0.5KHz, 1.0KHz, 2.0KHz and 4.0KHz was higher than that of the non-DPN group and the healthy control group (P0.05). The hearing threshold of the non-DPN group only in the frequency of 4.0 KHz was higher than that of the healthy control group (P0.05). The amplitude of DPOAE in the non-DPN group was only 4.0 KHz and the frequency of 8.0 KHz was lower than that of the healthy control group (p0.05).4. The amplitude of the DPOAE in the normal subjects in the three groups was compared, that is,19 patients in the DPN group,27 in the non-DPN group and 34 in the healthy control group. The results showed that the amplitude of DPOAE in DPN group was lower than that of healthy control group (P 0.01) at the frequency of 0.5 KHz, 1.0 KHz, 2.0 KHz, 4.0 KHz, and 8.0 KHz (P0.01). The frequency of DPOAE in the non-DPN group was lower than that of the healthy control group (P0.01). The frequency of DPOAE in the non-DPN group was lower than that of the healthy control group (P0.01). Spearman correlation analysis showed that the severity of DPN was positively correlated with the degree of hearing loss (Spearman correlation coefficient = 0.753).6. The multi-factor step-by-step logistic regression analysis results in the course of disease (regression coefficient = 0.195, P = 0.013), and the glycosylated hemoglobin (regression coefficient = 0.205, P = 0.001) is an independent risk factor for hearing loss. Conclusion:1. The hearing loss of type 2 diabetic patients is usually mild and moderate, most of them are high-frequency hearing impairment; the patients with diabetic peripheral neuropathy are often more likely to be combined with hearing loss, and the low-middle-high-frequency hearing is impaired.2. The course of the patients with type 2 diabetes is long, and the hyperglycemia may be more likely to be combined with hearing impairment. The patients with diabetes should actively control the blood sugar, and should pay more attention to the monitoring of the hearing in the early stage of diabetes, especially those with peripheral neuropathy.3. The otoacoustic emission of the distorted product can be used to evaluate the early cochlear damage in patients with type 2 diabetes and peripheral neuropathy.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 白樺;耳鳴、耳聾、眩暈與糖尿病[J];中國臨床醫(yī)生;2005年05期
，本文編號：2512551
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